Provider Demographics
NPI:1275546459
Name:CONTRERAS, CESAR (OWNER)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 GUS THOMASSON
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-3003
Mailing Address - Country:US
Mailing Address - Phone:214-823-9960
Mailing Address - Fax:214-823-6832
Practice Address - Street 1:2248 GUS THOMASSON
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-3003
Practice Address - Country:US
Practice Address - Phone:214-823-9960
Practice Address - Fax:214-823-6832
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009729251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677843Medicare Oscar/Certification