Provider Demographics
NPI:1053016832
Name:MONTELONGO HERNANDEZ, CESAR EBER
Entity type:Individual
Prefix:DR
First Name:CESAR
Middle Name:EBER
Last Name:MONTELONGO HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:CESAR
Other - Middle Name:
Other - Last Name:MONTELONGO HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, PH D
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:575-405-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10082977390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program