Provider Demographics
NPI:1437549193
Name:CERALDE, MENANDRO
Entity Type:Individual
Prefix:
First Name:MENANDRO
Middle Name:
Last Name:CERALDE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 PIERCE ST APT 533
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-5804
Mailing Address - Country:US
Mailing Address - Phone:310-357-0013
Mailing Address - Fax:
Practice Address - Street 1:3925 PIERCE ST APT 533
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-5804
Practice Address - Country:US
Practice Address - Phone:310-357-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA18693246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic