MEDICARE: PABLO DE LA CERDA PEREZ M.D.

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	207R00000X	Internal Medicine Physician	MT193987	PA

General Provider Information

NPI Number	:	1427213883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PABLO DE LA CERDA PEREZ M.D.

Provider Business Mailing Address
First Line	:	LAS PALMERAS N45-74 Y LAS ORQUIDEAS
Second Line	:
City	:	QUITO
State	:	PICHINCHA
Zip	:	EC 17-0124
Country	:	EC
Telephone Number	:	593999924048
Fax Number	:

Provider Business Practice Location Address
First Line	:	LAS PALMERAS N45-74 Y LAS ORQUIDEAS
Second Line	:
City	:	QUITO
State	:	PICHINCHA
Zip	:	EC 17-0124
Country	:	EC
Telephone Number	:	593999924048
Fax Number	:

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

Provider Enumeration Date	:	07/25/2008
Last Update Date	:	02/27/2013

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