Provider Demographics
NPI:1821556960
Name:CELESTIN, JOBED SR
Entity Type:Individual
Prefix:
First Name:JOBED
Middle Name:
Last Name:CELESTIN
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3667 CARAMBOLA CIR N
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2441
Mailing Address - Country:US
Mailing Address - Phone:954-804-6511
Mailing Address - Fax:954-780-5575
Practice Address - Street 1:1335 LYONS RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-3927
Practice Address - Country:US
Practice Address - Phone:954-804-6511
Practice Address - Fax:954-780-5575
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver