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General NPI Number Information
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NPI Number | 1649825001
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Entity Type | Individual
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Provider Name | MARLENE CERECERES
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Gender | Female
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 1211 W ILLINOIS AVE
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City | MIDLAND
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State | TX
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Zip | 79701-6158
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Country | US
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Telephone | 432-262-3822
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Fax |
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Provider Business Mailing Address
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Address Line | 3910 TANNER DR
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City | MIDLAND
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State | TX
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Zip | 79703-6143
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Country | US
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Telephone | 432-270-2373
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Fax |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA13915
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License Number State | TX
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