Provider Demographics
NPI:1942524863
Name:CEBALLOS, DESIREE NICOLE (BA)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:NICOLE
Last Name:CEBALLOS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 ANTHONY DR STE 3E
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-9346
Mailing Address - Country:US
Mailing Address - Phone:915-630-6955
Mailing Address - Fax:575-882-1879
Practice Address - Street 1:880 ANTHONY DR STE 3E
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9346
Practice Address - Country:US
Practice Address - Phone:915-630-6955
Practice Address - Fax:575-882-1879
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker