Provider Demographics
NPI:1174363477
Name:SURITA, CELESTINA ALMA
Entity type:Individual
Prefix:
First Name:CELESTINA
Middle Name:ALMA
Last Name:SURITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELESTINA
Other - Middle Name:ALMA
Other - Last Name:ALCALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9924 GREAT SKUA WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-6378
Mailing Address - Country:US
Mailing Address - Phone:916-826-5444
Mailing Address - Fax:
Practice Address - Street 1:9924 GREAT SKUA WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-6378
Practice Address - Country:US
Practice Address - Phone:916-826-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty