Provider Demographics
NPI:1285370320
Name:STA ANA, CELESTE EDORIA (PA-C)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:EDORIA
Last Name:STA ANA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950 S EASTERN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4971
Mailing Address - Country:US
Mailing Address - Phone:702-614-2192
Mailing Address - Fax:702-614-2190
Practice Address - Street 1:10950 S EASTERN AVE STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4971
Practice Address - Country:US
Practice Address - Phone:702-614-2191
Practice Address - Fax:702-614-2190
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2636363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty