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General NPI Number Information
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NPI Number | 1083166391
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Entity Type | Individual
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Provider Name | JORGE LUIS TAPIA CEDENO PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/03/2016
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 3711 ELMSLEY ST STE 101
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City | GREENSBORO
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State | NC
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Zip | 27406-7039
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Country | US
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Telephone | 336-890-2165
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Fax | 336-890-2166
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Provider Business Mailing Address
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Address Line | 300 E WENDOVER AVE
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City | GREENSBORO
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State | NC
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Zip | 27401-1229
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Country | US
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Telephone | 336-663-5205
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Fax | 336-663-5366
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 6022
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-15075
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License Number State | NC
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