Healthcare Provider Details

I. General information

NPI: 1972468171
Provider Name (Legal Business Name): CECYLI ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7909 FREDERICKSBURG RD
SAN ANTONIO TX
78229-3425
US

IV. Provider business mailing address

6611 EMBANKMENT RD
SAN ANTONIO TX
78252-4574
US

V. Phone/Fax

Practice location:
  • Phone: 301-265-5761
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number1057542
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: