Basic Information
| Provider Information | |||||||||
| NPI: | 1285600866 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CELEBERTI | ||||||||
| FirstName: | JULIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6002 N LIDGERWOOD ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992081124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094824402 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6002 N LIDGERWOOD ST | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992081124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094824402 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2006 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | M10740 | ID | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | G137950 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD60367308 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 808430500 | 05 | ID | MEDICAID |