Healthcare Provider Details

I. General information

NPI: 1104947472
Provider Name (Legal Business Name): CESAR M PELLERANO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20774 W DIXIE HWY
MIAMI FL
33180-1146
US

IV. Provider business mailing address

20774 W DIXIE HWY
MIAMI FL
33180-1146
US

V. Phone/Fax

Practice location:
  • Phone: 305-933-8877
  • Fax: 305-933-3244
Mailing address:
  • Phone: 305-933-8877
  • Fax: 305-933-3244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME35555
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CESAR M PELLERANO
Title or Position: PRESIDENT
Credential: MD
Phone: 305-933-8877