Healthcare Provider Details

I. General information

NPI: 1104409937
Provider Name (Legal Business Name): CEJA & SINGH A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 603-525-8007
  • Fax:
Mailing address:
  • Phone: 603-525-8007
  • Fax: 760-352-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LISA DAWN MEREDITH
Title or Position: MANAGER
Credential:
Phone: 276-613-0745