Provider Demographics
NPI:1851473268
Name:CELIS, EDGAR GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:GABRIEL
Last Name:CELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1050 NORTHGATE DR STE 460
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2542
Mailing Address - Country:US
Mailing Address - Phone:415-249-4244
Mailing Address - Fax:415-249-4245
Practice Address - Street 1:1050 NORTHGATE DR STE 460
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2542
Practice Address - Country:US
Practice Address - Phone:415-249-4244
Practice Address - Fax:415-249-4245
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME96425207L00000X
CAC131803207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology