Provider Demographics
NPI:1376659961
Name:PIZARRO, CECILIO D (MD)
Entity Type:Individual
Prefix:
First Name:CECILIO
Middle Name:D
Last Name:PIZARRO
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 1:1342 COLONIAL BLVD
Mailing Address - Street 2:BLDG. F # 41-A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1013
Mailing Address - Country:US
Mailing Address - Phone:239-415-7792
Mailing Address - Fax:239-274-3771
Practice Address - Street 1:1342 COLONIAL BLVD
Practice Address - Street 2:BLDG. F # 41-A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1013
Practice Address - Country:US
Practice Address - Phone:239-415-7792
Practice Address - Fax:239-274-3771
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME59711174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC12094Medicare UPIN
FL23526CMedicare ID - Type Unspecified