Provider Demographics
NPI:1447038914
Name:HERNANDEZ, CELESTE ELVIRA
Entity type:Individual
Prefix:MISS
First Name:CELESTE
Middle Name:ELVIRA
Last Name:HERNANDEZ
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 1:11011 78TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-7609
Mailing Address - Country:US
Mailing Address - Phone:360-502-5391
Mailing Address - Fax:
Practice Address - Street 1:11011 78TH AVE NE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-7609
Practice Address - Country:US
Practice Address - Phone:360-502-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician