Provider Demographics
NPI:1972049914
Name:CELAYA, ESTRELLITA
Entity Type:Individual
Prefix:
First Name:ESTRELLITA
Middle Name:
Last Name:CELAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 BERT GREEN DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-6017
Mailing Address - Country:US
Mailing Address - Phone:915-539-4278
Mailing Address - Fax:
Practice Address - Street 1:1508 BERT GREEN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6017
Practice Address - Country:US
Practice Address - Phone:915-539-4278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63439171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator