Basic Information
| Provider Information | |||||||||
| NPI: | 1982209730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CERDA | ||||||||
| FirstName: | JADE | ||||||||
| MiddleName: | GABRIELA | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 EXECUTIVE CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799021058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152131289 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6300 ROSA GANDARA PL | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799321876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158037327 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2020 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 958988 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.