Provider Demographics
NPI:1447236344
Name:CEREJO, MIGUEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:CEREJO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 DALLAS RANCH ROAD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94531-8811
Mailing Address - Country:US
Mailing Address - Phone:925-778-0679
Mailing Address - Fax:925-778-3567
Practice Address - Street 1:400 TAYLOR BLVD
Practice Address - Street 2:SUITE # 201
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2147
Practice Address - Country:US
Practice Address - Phone:925-687-2570
Practice Address - Fax:925-687-2847
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8747207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology