Provider Demographics
NPI:1053483289
Name:DELA CERNA, JAIME FORONDA (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:FORONDA
Last Name:DELA CERNA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:100 WILLOW PLAZA
Mailing Address - Street 2:STE 210
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6213
Mailing Address - Country:US
Mailing Address - Phone:559-625-5556
Mailing Address - Fax:559-625-5578
Practice Address - Street 1:100 WILLOW PLAZA
Practice Address - Street 2:STE 210
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6213
Practice Address - Country:US
Practice Address - Phone:559-625-5556
Practice Address - Fax:559-625-5578
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA032749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A327490Medicaid
CA00A327490Medicaid
00A327490Medicare ID - Type Unspecified