Healthcare Provider Details

I. General information

NPI: 1164519989
Provider Name (Legal Business Name): MARY CAIZZA CERNI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N ROSE DR SUITE 203
PLACENTIA CA
92870-3840
US

IV. Provider business mailing address

1325 N ROSE DR SUITE 203
PLACENTIA CA
92870-3840
US

V. Phone/Fax

Practice location:
  • Phone: 714-529-5674
  • Fax: 714-529-6122
Mailing address:
  • Phone: 714-529-5674
  • Fax: 714-529-6122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20A5318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: