Provider Demographics
NPI:1417250390
Name:SARANOVIC, CEDOMIR (PT)
Entity Type:Individual
Prefix:MR
First Name:CEDOMIR
Middle Name:
Last Name:SARANOVIC
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 E BONITA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3004
Mailing Address - Country:US
Mailing Address - Phone:626-261-0519
Mailing Address - Fax:
Practice Address - Street 1:149 E BONITA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3004
Practice Address - Country:US
Practice Address - Phone:626-261-0519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist