Provider Demographics
NPI:1780120303
Name:CEBALLOS, MARICELA (PHARMD)
Entity type:Individual
Prefix:
First Name:MARICELA
Middle Name:
Last Name:CEBALLOS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 E GRAYSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78208-1013
Mailing Address - Country:US
Mailing Address - Phone:469-613-3487
Mailing Address - Fax:210-764-5006
Practice Address - Street 1:818 E GRAYSON ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78208-1013
Practice Address - Country:US
Practice Address - Phone:469-613-3487
Practice Address - Fax:210-764-5006
Is Sole Proprietor?:No
Enumeration Date:2017-01-07
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist