MEDICARE: CENOVIO CAUDILLO

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1376996272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CENOVIO CAUDILLO

Provider Business Mailing Address
First Line	:	7755 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2104
Country	:	US
Telephone Number	:	713-729-8144
Fax Number	:	713-729-8147

Provider Business Practice Location Address
First Line	:	7755 W BELLFORT ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77071-2104
Country	:	US
Telephone Number	:	713-729-8144
Fax Number	:	713-729-8147

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

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	07/15/2016

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Directions to “ CENOVIO CAUDILLO ” Practice Location

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