MEDICARE: DR. ADOLFO NOEL CENIZA MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	4301066033	MI
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	T4324	TX
3	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036.162621	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	220026384	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1689657546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADOLFO NOEL CENIZA MD

Provider Business Mailing Address
First Line	:	11838 MEDPARK DR STE 103
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-0278
Country	:	US
Telephone Number	:	817-293-4304
Fax Number	:	817-293-7244

Provider Business Practice Location Address
First Line	:	11801 SOUTH FWY
Second Line	:
City	:	BURLESON
State	:	TX
Zip	:	76028-7021
Country	:	US
Telephone Number	:	817-293-4304
Fax Number	:	817-293-7244

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	09/05/2024

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