Provider Demographics
NPI:1730422510
Name:CEPEDA, ASHLEY M (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:M
Last Name:CEPEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 TRINITY PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7239
Mailing Address - Country:US
Mailing Address - Phone:209-472-2391
Mailing Address - Fax:
Practice Address - Street 1:10100 TRINITY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7239
Practice Address - Country:US
Practice Address - Phone:209-472-2391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA133810209800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program