Provider Demographics
NPI:1063673697
Name:CEDENO CEDENO, EVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVEN
Middle Name:
Last Name:CEDENO CEDENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560758
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-3758
Mailing Address - Country:US
Mailing Address - Phone:787-637-7872
Mailing Address - Fax:
Practice Address - Street 1:CALLE #2 PARCELA #214
Practice Address - Street 2:COMUNIDAD QUEBRADAS
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-3758
Practice Address - Country:US
Practice Address - Phone:787-637-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17447207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRGN105AMedicare PIN