Provider Demographics
NPI:1205825098
Name:CEDENO, VIRGINIA NELTA (OD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:NELTA
Last Name:CEDENO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PMB 50 LA CUMBRE
Mailing Address - Street 2:267 SIERRA MORENA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5639
Mailing Address - Country:US
Mailing Address - Phone:787-708-5821
Mailing Address - Fax:787-708-5821
Practice Address - Street 1:1790 AVE. LOMAS VERDES
Practice Address - Street 2:PLAZA OLMEDO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-708-5821
Practice Address - Fax:787-708-5821
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR497152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
077114OtherCRUZ AZUL PR
59373Medicare ID - Type Unspecified