Provider Demographics
NPI:1245230135
Name:CONCEPCION, CECILIA L (MD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:L
Last Name:CONCEPCION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:CECILIA
Other - Last Name:CONCEPCION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5501 HERRERA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2684
Mailing Address - Country:US
Mailing Address - Phone:505-913-3233
Mailing Address - Fax:505-913-3234
Practice Address - Street 1:5501 HERRERA DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2684
Practice Address - Country:US
Practice Address - Phone:505-913-3233
Practice Address - Fax:505-913-3234
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155789208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G19415Medicare UPIN