# MS. CAROL SUE CDEBACA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1154518900
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | 0110002628 | VA | Yes |

## Other

- **Enumeration date:** 09/26/2007
- **Last updated:** 04/23/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1154518900 | CCC VIRGINIA PREMIER | VA |
| 01 | — | 540506332115 | TRICARE | VA |
| 01 | — | P01464014 | RAILROAD MEDICARE | VA |