=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467567172
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | OSCAR J CERDA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 01/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5410 FREDERICKSBURG RD SUITE 112
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-733-3008
-----------------------------------------------------
Fax | 210-733-3002
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5410 FREDERICKSBURG RD SUITE 112
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78229-3554
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-733-3008
-----------------------------------------------------
Fax | 210-733-3002
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | K0672
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------