Healthcare Provider Details

I. General information

NPI: 1861214959
Provider Name (Legal Business Name): JAMES CHESTER CEREDON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 W CHEYENNE AVE STE 105
LAS VEGAS NV
89129-8411
US

IV. Provider business mailing address

7730 W CHEYENNE AVE STE 105
LAS VEGAS NV
89129
US

V. Phone/Fax

Practice location:
  • Phone: 702-869-4401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRC4080
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: