Provider Demographics
NPI:1447434089
Name:BUCK, CELES ELIZABETH (MICROPIGMENTATION)
Entity type:Individual
Prefix:
First Name:CELES
Middle Name:ELIZABETH
Last Name:BUCK
Suffix:
Gender:F
Credentials:MICROPIGMENTATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E DAILY DR STE 22
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-5805
Mailing Address - Country:US
Mailing Address - Phone:805-389-8993
Mailing Address - Fax:805-389-1886
Practice Address - Street 1:215 E DAILY DR STE 22
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5805
Practice Address - Country:US
Practice Address - Phone:805-389-8993
Practice Address - Fax:805-389-1886
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15210246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15210OtherCOUNTY LICENSE