Healthcare Provider Details

I. General information

NPI: 1770400376
Provider Name (Legal Business Name): CARMEN ROSA CEDENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395C CALLE SAN RAFAEL
SAN JUAN PR
00909-2518
US

IV. Provider business mailing address

4350 SW 158TH AVE
MIAMI FL
33185-3866
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-7620
  • Fax:
Mailing address:
  • Phone: 786-784-3197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17912-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: