Provider Demographics
NPI:1871694190
Name:MARTINEZ, CELESTE LISA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:LISA
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24165 W I H 10 STE 118
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1160
Mailing Address - Country:US
Mailing Address - Phone:210-698-7777
Mailing Address - Fax:210-698-1383
Practice Address - Street 1:24165 W I H 10 STE 118
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1160
Practice Address - Country:US
Practice Address - Phone:210-698-7777
Practice Address - Fax:210-698-1383
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04566363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS0148059OtherDPS
TXPA04566OtherSTATE LICENSE NUMBER