Healthcare Provider Details

I. General information

NPI: 1891753315
Provider Name (Legal Business Name): MARIO L CEJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 WEST COLE BOULEVARD
CALEXICO CA
92231-9722
US

IV. Provider business mailing address

2061 ROSS AVE STE B
EL CENTRO CA
92243-3687
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-3768
  • Fax: 877-355-1742
Mailing address:
  • Phone: 760-357-3768
  • Fax: 760-355-7731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG79700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: