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General NPI Number Information
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NPI Number | 1225068513
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Entity Type | Individual
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Provider Name | LOURDES CAROLINA CERON-CANAS MD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 05/17/2018
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Provider Practice Location Address
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Address Line | 1539 PARENTAL HOME RD
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City | JACKSONVILLE
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State | FL
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Zip | 32216
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Country | US
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Telephone | 904-338-0434
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Fax | 904-425-0821
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Provider Business Mailing Address
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Address Line | 13758 CLUB COVE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32225-5430
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Country | US
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Telephone | 904-891-9498
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | ME90074
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License Number State | FL
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