Provider Demographics
NPI:1720600612
Name:CELL-ED
Entity Type:Organization
Organization Name:CELL-ED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS - BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PCC
Authorized Official - Phone:509-956-8354
Mailing Address - Street 1:855 EL CAMINO REAL STE 13A-212
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2305
Mailing Address - Country:US
Mailing Address - Phone:650-444-6069
Mailing Address - Fax:
Practice Address - Street 1:855 EL CAMINO REAL STE 13A-212
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2305
Practice Address - Country:US
Practice Address - Phone:650-444-6069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty