Provider Demographics
NPI:1164703393
Name:VACLAVIK, CELIA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:MARIE
Last Name:VACLAVIK
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 1:27150 HIGHWAY 290 STE 100
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7224
Mailing Address - Country:US
Mailing Address - Phone:832-653-3300
Mailing Address - Fax:832-653-6407
Practice Address - Street 1:27150 HIGHWAY 290 STE 100
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-7224
Practice Address - Country:US
Practice Address - Phone:832-653-3300
Practice Address - Fax:832-653-6407
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841756236OtherGROUP NPI