Healthcare Provider Details

I. General information

NPI: 1346977733
Provider Name (Legal Business Name): CRISTINA CEDILLO HENDERSON PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 CARLOTTA DR
CONCORD CA
94519-1358
US

IV. Provider business mailing address

202 MARGIE DR
PLEASANT HILL CA
94523-2928
US

V. Phone/Fax

Practice location:
  • Phone: 925-682-8000
  • Fax:
Mailing address:
  • Phone: 510-940-3810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: