Provider Demographics
NPI:1831611656
Name:HONCULADA, CECE S (DPM)
Entity type:Individual
Prefix:DR
First Name:CECE
Middle Name:S
Last Name:HONCULADA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:CECE PASCUALA
Other - Middle Name:S
Other - Last Name:HONCULADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:9191 PINECROFT DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2797
Mailing Address - Country:US
Mailing Address - Phone:281-909-7722
Mailing Address - Fax:281-909-7733
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
211D00000X
TX3034213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric