Basic Information
| Provider Information | |||||||||
| NPI: | 1679631766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CEPEDA | ||||||||
| FirstName: | ELPIDIO | ||||||||
| MiddleName: | |||||||||
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| Credential: | L.P.T. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CEPEDA | ||||||||
| OtherFirstName: | PETE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LPT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1002 GRANADA ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MARIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934587324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059224039 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2178 JOHNSON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934014535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057882935 | ||||||||
| FaxNumber: | 8057811232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT22240 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.