Basic Information
| Provider Information | |||||||||
| NPI: | 1255768073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FAKHOURI | ||||||||
| FirstName: | CELIA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MESSENGER | ||||||||
| OtherFirstName: | CELIA | ||||||||
| OtherMiddleName: | KAY | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1839 S ALMA SCHOOL RD STE 354 | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852103028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807262287 | ||||||||
| FaxNumber: | 8885033312 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 E HUNT HWY STE A-2 | ||||||||
| Address2: | |||||||||
| City: | SAN TAN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 851434962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4808822222 | ||||||||
| FaxNumber: | 4808822220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2013 | ||||||||
| LastUpdateDate: | 09/14/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 7629170001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7047150001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7209350001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7045160001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7046960001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7057360001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332B00000X | 7034950001 | AZ | N | Suppliers | Durable Medical Equipment & Medical Supplies | 363A00000X | 5561 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.