MEDICARE: CESAR M PAREJA

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	1223G0001X	General Practice Dentistry	DN15781	FL

General Provider Information

NPI Number	:	1396847935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CESAR M PAREJA

Provider Business Mailing Address
First Line	:	1529 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-3927
Country	:	US
Telephone Number	:	321-725-6570
Fax Number	:

Provider Business Practice Location Address
First Line	:	1529 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-3927
Country	:	US
Telephone Number	:	321-725-6570
Fax Number	:

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

Provider Enumeration Date	:	09/03/2006
Last Update Date	:	07/05/2012

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