MEDICARE: JOSEPH CECAVA MS, RDN, LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD-1133	NM
2	133V00000X	Registered Dietitian	DT89725	TX

General Provider Information

NPI Number	:	1487165411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH CECAVA MS, RDN, LD

Provider Business Mailing Address
First Line	:	2183 FRONTIER DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-9005
Country	:	US
Telephone Number	:	575-635-1282
Fax Number	:

Provider Business Practice Location Address
First Line	:	2183 FRONTIER DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-9005
Country	:	US
Telephone Number	:	575-635-1282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2017
Last Update Date	:	03/19/2024

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