Provider Demographics
NPI:1679631766
Name:CEPEDA, ELPIDIO (LPT)
Entity Type:Individual
Prefix:
First Name:ELPIDIO
Middle Name:
Last Name:CEPEDA
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:PETE
Other - Middle Name:
Other - Last Name:CEPEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPT
Mailing Address - Street 1:1002 GRANADA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7324
Mailing Address - Country:US
Mailing Address - Phone:805-922-4039
Mailing Address - Fax:
Practice Address - Street 1:2178 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4535
Practice Address - Country:US
Practice Address - Phone:805-788-2935
Practice Address - Fax:805-781-1232
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22240167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician