Provider Demographics
NPI:1710011580
Name:CELESTINE, IVANOE (BA)
Entity Type:Individual
Prefix:
First Name:IVANOE
Middle Name:
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 N CHIPPEWA AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-4431
Mailing Address - Country:US
Mailing Address - Phone:562-692-0383
Mailing Address - Fax:562-692-0380
Practice Address - Street 1:10155 COLIMA RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2063
Practice Address - Country:US
Practice Address - Phone:562-692-0383
Practice Address - Fax:562-692-0380
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator