1407445117 NPI number — CELINA RANAE WAYMENT

Table of content: CELINA RANAE WAYMENT (NPI 1407445117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407445117 NPI number — CELINA RANAE WAYMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAYMENT
Provider First Name:
CELINA
Provider Middle Name:
RANAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407445117
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 E. COLORADO BLVD. SUITE 560
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-241-6780
Provider Business Mailing Address Fax Number:
818-241-6853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
662 ENCINITAS BLVD STE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-6789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-634-1125
Provider Business Practice Location Address Fax Number:
760-634-1530
Provider Enumeration Date:
01/16/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)