Provider Demographics
NPI:1144369174
Name:CECILIO, KARINA LIS (MD)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:LIS
Last Name:CECILIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 N. PIEDRAS ST
Mailing Address - Street 2:ATTN: MCHM-ACM
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-1439
Mailing Address - Fax:915-744-6079
Practice Address - Street 1:5005 N. PIEDRAS ST
Practice Address - Street 2:ATTN: MCHM-ACM
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-1439
Practice Address - Fax:915-744-6079
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2005-0281208000000X
CAA104932208000000X
TXN3032208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics