Healthcare Provider Details

I. General information

NPI: 1841053071
Provider Name (Legal Business Name): ALEJANDRO ENRIQUE CEDENO MORAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. LOS MONTES, CLL. PERDIGON #572
DORADO PR
00646
US

IV. Provider business mailing address

PO BOX 3022
VEGA ALTA PR
00692-3022
US

V. Phone/Fax

Practice location:
  • Phone: 787-908-9805
  • Fax:
Mailing address:
  • Phone: 787-908-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number438-E
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: