Provider Demographics
NPI:1073264321
Name:CELENTANO, CHAUNDA CLARISHA (DNP, FNP-C, CPNP-PC)
Entity type:Individual
Prefix:DR
First Name:CHAUNDA
Middle Name:CLARISHA
Last Name:CELENTANO
Suffix:
Gender:F
Credentials:DNP, FNP-C, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 POMONA AVE
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2339
Mailing Address - Country:US
Mailing Address - Phone:310-913-9583
Mailing Address - Fax:
Practice Address - Street 1:5500 CAMPANILE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92182-5698
Practice Address - Country:US
Practice Address - Phone:619-594-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218659207Q00000X
CA95015487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty