Provider Demographics
NPI:1063961001
Name:CERDINA, ERNESTO VASQUEZ
Entity type:Individual
Prefix:MR
First Name:ERNESTO
Middle Name:VASQUEZ
Last Name:CERDINA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ERNESTO
Other - Middle Name:VASQUEZ
Other - Last Name:CERDINA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2715 RED LION CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2757
Mailing Address - Country:US
Mailing Address - Phone:361-510-1760
Mailing Address - Fax:
Practice Address - Street 1:2715 RED LION CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2757
Practice Address - Country:US
Practice Address - Phone:361-510-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily