Healthcare Provider Details

I. General information

NPI: 1396934402
Provider Name (Legal Business Name): JAMES S CERNEKA DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2007
Last Update Date: 10/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W 10TH PL STE 120
MESA AZ
85201-3218
US

IV. Provider business mailing address

500 W 10TH PL STE 120
MESA AZ
85201-3218
US

V. Phone/Fax

Practice location:
  • Phone: 480-545-2610
  • Fax: 480-545-2673
Mailing address:
  • Phone: 480-545-2610
  • Fax: 480-545-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES S CERNEKA
Title or Position: OWNER
Credential: DO
Phone: 480-545-2610