Provider Demographics
NPI:1528616935
Name:CEREBELLA LLC
Entity type:Organization
Organization Name:CEREBELLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-696-9292
Mailing Address - Street 1:16019 VIA SHAVANO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2370
Mailing Address - Country:US
Mailing Address - Phone:210-696-9292
Mailing Address - Fax:210-690-8815
Practice Address - Street 1:16019 VIA SHAVANO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2370
Practice Address - Country:US
Practice Address - Phone:210-696-9292
Practice Address - Fax:210-690-8815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty