Provider Demographics
NPI:1861079329
Name:FODING FOTSO, CESAR PAULIN
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:PAULIN
Last Name:FODING FOTSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 TEALRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6338
Mailing Address - Country:US
Mailing Address - Phone:972-246-9466
Mailing Address - Fax:
Practice Address - Street 1:404 TEALRIDGE CT
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6338
Practice Address - Country:US
Practice Address - Phone:972-246-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41577134172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver