MEDICARE: AIDEE GICEL CEDILLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073238960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIDEE GICEL CEDILLO

Provider Business Mailing Address
First Line	:	5479 MCGANN DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-5508
Country	:	US
Telephone Number	:	619-831-1817
Fax Number	:

Provider Business Practice Location Address
First Line	:	5479 MCGANN DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-5508
Country	:	US
Telephone Number	:	619-831-1817
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/10/2022

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Directions to “ AIDEE GICEL CEDILLO ” Practice Location

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