Healthcare Provider Details

I. General information

NPI: 1497747828
Provider Name (Legal Business Name): CARLOS J CEDO ALZAMORA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIF LA PALMA PERAL #14 ESQUINA DE DIEGO APT 2 F
MAYAGUEZ PR
00680-4861
US

IV. Provider business mailing address

PO BOX 3479
MAYAGUEZ PR
00681-3479
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-1113
  • Fax: 787-831-2380
Mailing address:
  • Phone: 787-833-1113
  • Fax: 787-831-2380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number3969
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: