Individual
CELINA PROVENCIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2205 POST ST, SAN FRANCISCO, CA 94115-3427
(415) 390-6511
(415) 592-1617
Mailing address
1654 151ST AVE, SAN LEANDRO, CA 94578-1956
(520) 240-5118
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/26/2021
Last updated
10/05/2023
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