Individual
CECILIA E. CHAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
PO BOX 187, JICARILLA SERVICE UNIT, DULCE, NM 87528-0187
(505) 759-3291
(505) 759-7294
Mailing address
PO BOX 1095, TWO BEAR RUN, CHAMA, NM 87520-1095
(505) 756-2582
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD2005-0220
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
8HE353
PROVIDER NO.
NM
05
—
92531547
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
07/28/2006
Last updated
02/14/2017
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