Provider Demographics
NPI:1124079702
Name:ARMENTA, CELESTE L (RN, MSN, NP)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:L
Last Name:ARMENTA
Suffix:
Gender:F
Credentials:RN, MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9610 GRANITE RIDGE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2684
Mailing Address - Country:US
Mailing Address - Phone:858-810-8000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:2205 ROSS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3623
Practice Address - Country:US
Practice Address - Phone:760-353-0404
Practice Address - Fax:760-353-0392
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15871363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP15871OtherNURSE PRACTITIONER LICENS
CAEK495YOtherSO. CALIFORNIA PTAN