MEDICARE: DR. JORGE CEDENO ESPAILLAT 17552

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	17552	PR

General Provider Information

NPI Number	:	1316171168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE CEDENO ESPAILLAT 17552

Provider Business Mailing Address
First Line	:	URB MARINA BAHIA ME10
Second Line	:	PLAZA 20
City	:	CATANO
State	:	PR
Zip	:	00962-0000
Country	:	US
Telephone Number	:	787-784-2218
Fax Number	:

Provider Business Practice Location Address
First Line	:	610 AVE. COMERIO FINAL
Second Line	:	SUP ECONO LEVITTOWN
City	:	TOA BAJA
State	:	PR
Zip	:	00949-0000
Country	:	US
Telephone Number	:	787-784-2218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2009
Last Update Date	:	05/22/2014

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