Provider Demographics
NPI:1821135997
Name:CEDILLO, ALFREDO (LSA)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:CEDILLO
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922
Mailing Address - Country:US
Mailing Address - Phone:915-587-7888
Mailing Address - Fax:915-587-7888
Practice Address - Street 1:769 WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922
Practice Address - Country:US
Practice Address - Phone:915-587-7888
Practice Address - Fax:915-587-7888
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA0059208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0010JROtherBCBS