Provider Demographics
NPI:1306185749
Name:CELIS, MARIA I (PA)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:I
Last Name:CELIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 PECAN GRV
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-6364
Mailing Address - Country:US
Mailing Address - Phone:409-770-7470
Mailing Address - Fax:
Practice Address - Street 1:417 PECAN GRV
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-6364
Practice Address - Country:US
Practice Address - Phone:409-770-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant