MEDICARE: SELENA CERMENO D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC31003	CA

General Provider Information

NPI Number	:	1205085727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELENA CERMENO D.C.

Provider Business Mailing Address
First Line	:	3028 SHADOW SPRINGS PL
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1751
Country	:	US
Telephone Number	:	408-482-7775
Fax Number	:	831-771-1772

Provider Business Practice Location Address
First Line	:	3028 SHADOW SPRINGS PL
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95121-1751
Country	:	US
Telephone Number	:	408-482-7775
Fax Number	:	831-771-1772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	09/09/2008

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