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Individual
MS. CAROL SUE CDEBACA
Active
Individual
MS. CAROL SUE CDEBACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
0110002628
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154518900
CCC VIRGINIA PREMIER
VA
01
—
540506332115
TRICARE
VA
01
—
P01464014
RAILROAD MEDICARE
VA
Enumeration date
09/26/2007
Last updated
04/23/2025
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