Provider Demographics
NPI:1154121143
Name:BAXTER, CECILIA MARIE (PARAMEDICAL TATTOO)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:MARIE
Last Name:BAXTER
Suffix:
Gender:
Credentials:PARAMEDICAL TATTOO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11821 FM 1488 RD LOT 1A
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-7137
Mailing Address - Country:US
Mailing Address - Phone:832-521-3305
Mailing Address - Fax:
Practice Address - Street 1:11821 FM 1488 RD LOT 1A
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-7137
Practice Address - Country:US
Practice Address - Phone:832-521-3305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty