Healthcare Provider Details

I. General information

NPI: 1346875002
Provider Name (Legal Business Name): HORACIO CERDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 CEDAR SPRINGS RD
DALLAS TX
75219-2691
US

IV. Provider business mailing address

4235 CEDAR SPRINGS RD
DALLAS TX
75219-2691
US

V. Phone/Fax

Practice location:
  • Phone: 469-906-6372
  • Fax:
Mailing address:
  • Phone: 469-906-6372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: