Healthcare Provider Details

I. General information

NPI: 1245230986
Provider Name (Legal Business Name): JESUS A. CEBOLLERO-PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MJ CABRERO 66 ALTOS
SAN SEBASTIAN PR
00685-1610
US

IV. Provider business mailing address

PO BOX 1610
SAN SEBASTIAN PR
00685-1610
US

V. Phone/Fax

Practice location:
  • Phone: 787-896-9052
  • Fax: 787-896-9052
Mailing address:
  • Phone: 787-896-9052
  • Fax: 787-896-9052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6334
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: