Provider Demographics
NPI:1164519989
Name:CERNI, MARY CAIZZA (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAIZZA
Last Name:CERNI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1325 N ROSE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3840
Mailing Address - Country:US
Mailing Address - Phone:714-529-5674
Mailing Address - Fax:714-529-6122
Practice Address - Street 1:1325 N ROSE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3840
Practice Address - Country:US
Practice Address - Phone:714-529-5674
Practice Address - Fax:714-529-6122
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5318207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF0732ZOtherMEDICARE PTAN
CAP01003098OtherRAILROAD MEDICARE
CAF0732ZOtherMEDICARE PTAN