Provider Demographics
NPI:1629889563
Name:MONTALVO-CEDILLO, KASSANDRA TERESA
Entity type:Individual
Prefix:MRS
First Name:KASSANDRA
Middle Name:TERESA
Last Name:MONTALVO-CEDILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 ROCIO DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6676
Mailing Address - Country:US
Mailing Address - Phone:956-645-9569
Mailing Address - Fax:
Practice Address - Street 1:7616 ROCIO DR STE 102
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6676
Practice Address - Country:US
Practice Address - Phone:956-645-9569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1185944363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner