Provider Demographics
NPI:1699716548
Name:PELE, CELINE THERESA (PA)
Entity type:Individual
Prefix:
First Name:CELINE
Middle Name:THERESA
Last Name:PELE
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 1:2424 BOLIER AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3307
Mailing Address - Country:US
Mailing Address - Phone:707-839-5626
Mailing Address - Fax:707-822-0138
Practice Address - Street 1:3800 JANES RD
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-4742
Practice Address - Country:US
Practice Address - Phone:707-826-8264
Practice Address - Fax:707-826-8292
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA15144Medicaid
CA0PA151441Medicare PIN
CAQ18892Medicare UPIN
CAPA15144Medicaid