Provider Demographics
NPI:1245230986
Name:CEBOLLERO-PEREZ, JESUS A (MD)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:A
Last Name:CEBOLLERO-PEREZ
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 1610
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-1610
Mailing Address - Country:US
Mailing Address - Phone:787-896-9052
Mailing Address - Fax:787-896-9052
Practice Address - Street 1:CALLE MJ CABRERO 66 ALTOS
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-1610
Practice Address - Country:US
Practice Address - Phone:787-896-9052
Practice Address - Fax:787-896-9052
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6334208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics