Provider Demographics
NPI:1649499658
Name:FENOGLIO-PREISER, CECILIA (MD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:FENOGLIO-PREISER
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 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1661 E CAMELBACK RD
Practice Address - Street 2:STE 140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3911
Practice Address - Country:US
Practice Address - Phone:602-441-2000
Practice Address - Fax:602-441-2034
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-0868-F207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0871589Medicaid
IN200000830AMedicaid
KY64865934Medicaid
KY64865934Medicaid
OHB13289Medicare UPIN