Provider Demographics
NPI:1184095648
Name:CEPEDA, CARMEN GRISELDA (RN/BSN)
Entity type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:GRISELDA
Last Name:CEPEDA
Suffix:
Gender:F
Credentials:RN/BSN
Other - Prefix:MRS
Other - First Name:CARMEN
Other - Middle Name:GRISELDA
Other - Last Name:CEPEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CARMEN CEPEDA
Mailing Address - Street 1:6419 MCTHERSON ST
Mailing Address - Street 2:SUITE I
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-462-7446
Mailing Address - Fax:
Practice Address - Street 1:6419 MCTHERSON ST
Practice Address - Street 2:SUITE I
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-462-7446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653125171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator