Provider Demographics
NPI:1366430985
Name:TEXIDOR, CESAREO (PA)
Entity type:Individual
Prefix:
First Name:CESAREO
Middle Name:
Last Name:TEXIDOR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SW FRAZER AVE
Mailing Address - Street 2:SUITE 282
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2163
Mailing Address - Country:US
Mailing Address - Phone:541-278-3377
Mailing Address - Fax:541-278-2434
Practice Address - Street 1:17 SW FRAZER AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2163
Practice Address - Country:US
Practice Address - Phone:541-278-3377
Practice Address - Fax:541-278-2434
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR01110363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical