Celisa Chan
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Portales, NM
NPI 1720756752 · NPPES record last updated Sep 3, 2021
Key facts
- NPI
- 1720756752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 1500 S Ave K
Station 3, Shroc
Portales, NM 88130 - Phone
- (575) 562-2160
- NPI assigned
- Sep 3, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eastern New Mexico University | Current |
Accepting new patients |
Locations
1500 S Avenue K
#3
Portales, NM 88130
Phone (575) 562-2156
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
1500 S Ave K
Station 3, Shroc
Portales, NM 88130
Mailing address
1500 S Avenue K
Station 3, Shroc
Portales, NM 88130
Other providers in Portales, NM
- Jana Carn
- Wade Carter
- Johnny G Casady
- Leah Jayne Castro
- Madeline K Chalenor
- Charles W. Brooks, O.D., P.C.
- Praveen Chava
- Deborah L Chavez
- Tiffany C Cheung
- Lindsay D Christensen
All providers in Portales, NM · Student in an Organized Health Care Education/Training Program in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.