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General NPI Number Information
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NPI Number | 1477043180
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Entity Type | Organization
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Legal Business Name | CERON PEDIATRICS AND INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 05/17/2018
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Last Update Date | 04/12/2019
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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 | 32216-3009
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Country | US
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Telephone | 904-338-0434
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Fax |
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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 | 904-425-0821
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Authorized Official
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Title or Position | OWNER
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Name | LOURDES CAROLINA CERON CANAS
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Credential | MD
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Telephone | 904-891-9498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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