Provider Demographics
NPI:1255768073
Name:FAKHOURI, CELIA KAY (PA-C)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:KAY
Last Name:FAKHOURI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CELIA
Other - Middle Name:KAY
Other - Last Name:MESSENGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3815 E BELL RD STE 4500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2171
Mailing Address - Country:US
Mailing Address - Phone:602-633-3848
Mailing Address - Fax:602-633-3841
Practice Address - Street 1:7165 E UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-6400
Practice Address - Country:US
Practice Address - Phone:480-750-0085
Practice Address - Fax:480-664-8105
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7209350001332B00000X
AZ7046960001332B00000X
AZ7629170001332B00000X
AZ7057360001332B00000X
AZ7045160001332B00000X
AZ7047150001332B00000X
AZ7034950001332B00000X
363A00000X
AZ5561363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies