Provider Demographics
NPI:1144465493
Name:WATERS, CELESTE BIANCHA (MD)
Entity type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:BIANCHA
Last Name:WATERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3623
Mailing Address - Country:US
Mailing Address - Phone:805-543-2254
Mailing Address - Fax:805-464-0149
Practice Address - Street 1:1025 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3623
Practice Address - Country:US
Practice Address - Phone:805-543-2254
Practice Address - Fax:805-464-0149
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA545232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry