Provider Demographics
NPI:1356034730
Name:CELEBRACES CHEYENNE, PLLC
Entity type:Organization
Organization Name:CELEBRACES CHEYENNE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL ORTHO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-397-9279
Mailing Address - Street 1:5900 W CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4203
Mailing Address - Country:US
Mailing Address - Phone:702-674-7000
Mailing Address - Fax:
Practice Address - Street 1:5900 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4203
Practice Address - Country:US
Practice Address - Phone:702-674-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental