Provider Demographics
NPI:1902268857
Name:CELESTE, GAUDENCIO FUENTES
Entity Type:Individual
Prefix:MR
First Name:GAUDENCIO
Middle Name:FUENTES
Last Name:CELESTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DENNIS
Other - Middle Name:FUENTES
Other - Last Name:CELESTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:8674 134TH ST W
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7234
Mailing Address - Country:US
Mailing Address - Phone:952-452-2827
Mailing Address - Fax:
Practice Address - Street 1:8674 134TH ST W
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-7234
Practice Address - Country:US
Practice Address - Phone:952-452-2827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-21
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9275311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home