Provider Demographics
NPI:1962956219
Name:CELAYA, LINDLE
Entity type:Individual
Prefix:
First Name:LINDLE
Middle Name:
Last Name:CELAYA
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 1:6000 W SUNSHINE LN
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658-4133
Mailing Address - Country:US
Mailing Address - Phone:520-429-9289
Mailing Address - Fax:
Practice Address - Street 1:6000 W SUNSHINE LN
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658-4133
Practice Address - Country:US
Practice Address - Phone:520-429-9289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5495208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice