Provider Demographics
NPI:1912219742
Name:OWEN, CELESTA RANNISI (LM)
Entity Type:Individual
Prefix:
First Name:CELESTA
Middle Name:RANNISI
Last Name:OWEN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9936 CHOCOLATE SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2612
Mailing Address - Country:US
Mailing Address - Phone:619-443-0165
Mailing Address - Fax:
Practice Address - Street 1:9936 CHOCOLATE SUMMIT DR
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-2612
Practice Address - Country:US
Practice Address - Phone:619-443-0165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM0038176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife