Provider Demographics
NPI:1669363230
Name:MONTALVO, CELESTE DESIREE (FNP)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:DESIREE
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 SANTA CLARA AVE APT B
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-2566
Mailing Address - Country:US
Mailing Address - Phone:310-754-6236
Mailing Address - Fax:
Practice Address - Street 1:1455 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6502
Practice Address - Country:US
Practice Address - Phone:707-559-7500
Practice Address - Fax:707-238-1426
Is Sole Proprietor?:No
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily