Provider Demographics
NPI:1134187958
Name:GENIO-HARDING, CEILA (MD)
Entity type:Individual
Prefix:
First Name:CEILA
Middle Name:
Last Name:GENIO-HARDING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12606 GREENVILLE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-1926
Mailing Address - Country:US
Mailing Address - Phone:214-292-0072
Mailing Address - Fax:214-292-0044
Practice Address - Street 1:12606 GREENVILLE AVE STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-1926
Practice Address - Country:US
Practice Address - Phone:214-292-0072
Practice Address - Fax:214-292-0044
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ46472080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046074303Medicaid