Provider Demographics
NPI:1427213883
Name:DE LA CERDA PEREZ, PABLO (MD)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:DE LA CERDA 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:LAS PALMERAS N45-74 Y LAS ORQUIDEAS
Mailing Address - Street 2:
Mailing Address - City:QUITO
Mailing Address - State:PICHINCHA
Mailing Address - Zip Code:EC 170124
Mailing Address - Country:EC
Mailing Address - Phone:59399-992-4048
Mailing Address - Fax:
Practice Address - Street 1:LAS PALMERAS N45-74 Y LAS ORQUIDEAS
Practice Address - Street 2:
Practice Address - City:QUITO
Practice Address - State:PICHINCHA
Practice Address - Zip Code:EC 170124
Practice Address - Country:EC
Practice Address - Phone:59399-992-4048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT193987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine