Provider Demographics
NPI:1447960042
Name:CELIS, MELANIE ALEJANDRA
Entity type:Individual
Prefix:MISS
First Name:MELANIE
Middle Name:ALEJANDRA
Last Name:CELIS
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 1:5178 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-6510
Mailing Address - Country:US
Mailing Address - Phone:818-654-3912
Mailing Address - Fax:818-936-0114
Practice Address - Street 1:5178 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-6510
Practice Address - Country:US
Practice Address - Phone:818-654-3912
Practice Address - Fax:818-936-0114
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator