Provider Demographics
NPI:1033282629
Name:JUAN CARLOS DE LA CERDA
Entity Type:Organization
Organization Name:JUAN CARLOS DE LA CERDA
Other - Org Name:SONO DIAGNOSTICS OF WEST TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:DE LE CERDA
Authorized Official - Suffix:
Authorized Official - Credentials:RVT, RVS, RDCS, RCS
Authorized Official - Phone:806-791-5930
Mailing Address - Street 1:PO BOX 54136
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79453-4136
Mailing Address - Country:US
Mailing Address - Phone:806-771-1386
Mailing Address - Fax:806-771-1388
Practice Address - Street 1:1902 50TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2706
Practice Address - Country:US
Practice Address - Phone:806-771-1386
Practice Address - Fax:806-771-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25718247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0147DCOtherBLUE CROSS BLUE SHIELD
TX00MDXOOtherBLUE CROSS BLUE SHIELD
TXFTCV07Medicare ID - Type Unspecified