Provider Demographics
NPI:1417436015
Name:ACEBEDO, SEAN ERIC (CRNA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:ERIC
Last Name:ACEBEDO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 ESCONDIDO LN E APT B
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-0058
Mailing Address - Country:US
Mailing Address - Phone:956-254-3356
Mailing Address - Fax:
Practice Address - Street 1:3008 N GLASSCOCK RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-2021
Practice Address - Country:US
Practice Address - Phone:956-254-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140329367500000X
TX766821163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse