Provider Demographics
NPI:1912577032
Name:CEDILLO, CHRISTOPHER JOSE
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JOSE
Last Name:CEDILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11525 FEBRUARY CIR APT 201
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-6988
Mailing Address - Country:US
Mailing Address - Phone:301-569-0792
Mailing Address - Fax:
Practice Address - Street 1:11525 FEBRUARY CIR APT 201
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-6988
Practice Address - Country:US
Practice Address - Phone:301-569-0792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant