Provider Demographics
NPI:1376996272
Name:CAUDILLO, CENOVIO
Entity Type:Individual
Prefix:
First Name:CENOVIO
Middle Name:
Last Name:CAUDILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7755 W BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2104
Mailing Address - Country:US
Mailing Address - Phone:713-729-8144
Mailing Address - Fax:713-729-8147
Practice Address - Street 1:7755 W BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77071-2104
Practice Address - Country:US
Practice Address - Phone:713-729-8144
Practice Address - Fax:713-729-8147
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician