Provider Demographics
NPI:1437136207
Name:VAN BIBBER, CECILIA A (MD)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:A
Last Name:VAN BIBBER
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:HEALTH BY DESIGN
Mailing Address - Street 2:13409 GEORGE RD
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230
Mailing Address - Country:US
Mailing Address - Phone:210-345-4855
Mailing Address - Fax:210-479-2010
Practice Address - Street 1:HEALTH BY DESIGN
Practice Address - Street 2:13409 GEORGE RD
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-345-4855
Practice Address - Fax:210-479-2010
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8478208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124991402Medicaid
TXE54777Medicare UPIN
TX822062Medicare ID - Type Unspecified