Provider Demographics
NPI:1932349537
Name:PARKE, CELESTE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:
Last Name:PARKE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MISS
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:WELTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:499 N EL CAMINO REAL
Mailing Address - Street 2:SUITE C202
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1366
Mailing Address - Country:US
Mailing Address - Phone:760-230-8151
Mailing Address - Fax:760-452-7975
Practice Address - Street 1:499 N EL CAMINO REAL
Practice Address - Street 2:SUITE C202
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1366
Practice Address - Country:US
Practice Address - Phone:760-230-8151
Practice Address - Fax:760-452-7975
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12861171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC12861OtherCALIFORNIA STATE ACUPUNCTURE BOARD