Provider Demographics
NPI:1871108779
Name:CEBALLOS, ALMA ROSALIA
Entity type:Individual
Prefix:MISS
First Name:ALMA
Middle Name:ROSALIA
Last Name:CEBALLOS
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 1:2110 LEE ST APT B
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604-1919
Mailing Address - Country:US
Mailing Address - Phone:903-315-8342
Mailing Address - Fax:
Practice Address - Street 1:2110 LEE ST APT B
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1919
Practice Address - Country:US
Practice Address - Phone:903-315-8342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX903045163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse