Provider Demographics
NPI:1699979062
Name:GERALDE, CECILIA BACERDO (DO)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:BACERDO
Last Name:GERALDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20188-0417
Mailing Address - Country:US
Mailing Address - Phone:714-598-6699
Mailing Address - Fax:
Practice Address - Street 1:22827 STEEPLE BLUFF
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78256
Practice Address - Country:US
Practice Address - Phone:949-235-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics