MEDICARE: NICOLAS CERNEY

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	235Z00000X	Speech-Language Pathologist	19331	CA

General Provider Information

NPI Number	:	1932468279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLAS CERNEY

Provider Business Mailing Address
First Line	:	9960 EL GRANITO AVE
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-4311
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5665 OBERLIN DR STE 201
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1739
Country	:	US
Telephone Number	:	858-558-9552
Fax Number	:

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

Provider Enumeration Date	:	05/07/2012
Last Update Date	:	05/07/2012

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Directions to “ NICOLAS CERNEY ” Practice Location

Language	Start Address	Practice Location

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