1528645694 NPI number — MRS. CELESTE MARIE MENDEZ PMHNP-BC

Table of content: MRS. CELESTE MARIE MENDEZ PMHNP-BC (NPI 1528645694)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528645694 NPI number — MRS. CELESTE MARIE MENDEZ PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENDEZ
Provider First Name:
CELESTE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
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:
1528645694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 562
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SENECA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29679-0562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-614-1555
Provider Business Mailing Address Fax Number:
312-535-6816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 ROBIN DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SENECA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29678-2653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-614-1555
Provider Business Practice Location Address Fax Number:
312-535-6816
Provider Enumeration Date:
03/25/2021

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: 363LP0808X , with the licence number:  APN.24781APRN , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com