Provider Demographics
NPI:1861147985
Name:SPEARS, CELIA MAE (LVN)
Entity type:Individual
Prefix:
First Name:CELIA
Middle Name:MAE
Last Name:SPEARS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15704 TOURAINE CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4923
Mailing Address - Country:US
Mailing Address - Phone:951-300-3060
Mailing Address - Fax:
Practice Address - Street 1:23890 ALESSANDRO BLVD STE A2
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8801
Practice Address - Country:US
Practice Address - Phone:951-305-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN208446164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty