MEDICARE: NIKOL CEPEDA

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1871486597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIKOL CEPEDA

Provider Business Mailing Address
First Line	:	3918 CLARK AVE UNIT 23295
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-0676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3918 CLARK AVE UNIT 23295
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-0676
Country	:	US
Telephone Number	:	726-777-0711
Fax Number	:

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

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	06/02/2025

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Directions to “ NIKOL CEPEDA ” Practice Location

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