Provider Demographics
NPI:1801426903
Name:COLLINS, CELESTINE (PCA/ MA)
Entity type:Individual
Prefix:
First Name:CELESTINE
Middle Name:
Last Name:COLLINS
Suffix:
Gender:F
Credentials:PCA/ MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3370 S PECOS RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3747
Mailing Address - Country:US
Mailing Address - Phone:702-689-1508
Mailing Address - Fax:
Practice Address - Street 1:3370 S PECOS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3747
Practice Address - Country:US
Practice Address - Phone:702-689-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV770428778174200000X, 177F00000X
251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging