Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 24884 | CA |
NPI | 1013257831 |
---|---|
Provider Name | Ms. Kimberly Jill Celeri |
First Address | Fort Bragg, CA 95437-5540 |
Second Address | Fort Bragg, CA 95437-5540 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2013 |
Last Update Date | 15/02/2013 |