Provider Demographics
NPI:1063612273
Name:GARCIA, CELESTE (SLP)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3810
Mailing Address - Country:US
Mailing Address - Phone:956-487-8100
Mailing Address - Fax:956-487-8155
Practice Address - Street 1:506 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-3810
Practice Address - Country:US
Practice Address - Phone:956-487-8100
Practice Address - Fax:956-487-8155
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102075235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205122901Medicaid