Provider Demographics
NPI:1124842554
Name:CEPEDA, CARLOS (PA)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:CEPEDA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22618 AUBURN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2205
Mailing Address - Country:US
Mailing Address - Phone:832-836-0651
Mailing Address - Fax:
Practice Address - Street 1:22618 AUBURN VALLEY LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2205
Practice Address - Country:US
Practice Address - Phone:832-836-0651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1870363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant