Provider Demographics
NPI:1649616780
Name:CELIS, KRYSTLE A (MS, ATC)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:A
Last Name:CELIS
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 JAMES CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-1405
Mailing Address - Country:US
Mailing Address - Phone:650-270-7554
Mailing Address - Fax:
Practice Address - Street 1:1570 S DISNEYLAND DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2321
Practice Address - Country:US
Practice Address - Phone:650-270-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer