Provider Demographics
NPI:1790399699
Name:ZEPEDA-CISNEROS, ELODIA
Entity Type:Individual
Prefix:
First Name:ELODIA
Middle Name:
Last Name:ZEPEDA-CISNEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89433-7205
Mailing Address - Country:US
Mailing Address - Phone:775-657-0026
Mailing Address - Fax:
Practice Address - Street 1:535 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:SUN VALLEY
Practice Address - State:NV
Practice Address - Zip Code:89433-7205
Practice Address - Country:US
Practice Address - Phone:775-657-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health