Provider Demographics
NPI:1316958788
Name:CELONI, BERNARDINE ANDREA (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARDINE
Middle Name:ANDREA
Last Name:CELONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BERNARDINE
Other - Middle Name:ANDREA
Other - Last Name:HILLSETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:65 N 1ST AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3207
Mailing Address - Country:US
Mailing Address - Phone:626-445-2233
Mailing Address - Fax:626-445-7421
Practice Address - Street 1:65 N 1ST AVE
Practice Address - Street 2:STE 104
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3207
Practice Address - Country:US
Practice Address - Phone:626-445-2233
Practice Address - Fax:626-445-7421
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-034904208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013047OtherAMER ACAD OF PEDIATRICS
64914764244OtherME (MED EDUC) VIA AMA
1013047OtherAMER ACAD OF PEDIATRICS