Provider Demographics
NPI:1194537993
Name:BURLES, CELINA MARIE
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:MARIE
Last Name:BURLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 DAWSON CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3018
Mailing Address - Country:US
Mailing Address - Phone:805-573-1107
Mailing Address - Fax:
Practice Address - Street 1:1653 DAWSON CT
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3018
Practice Address - Country:US
Practice Address - Phone:805-573-1107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program