Provider Demographics
NPI:1538119797
Name:BERROA, CESAR A
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:A
Last Name:BERROA
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:PASEO PUERTARIO S
Mailing Address - Street 2:1212 CALLE CASTILLA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901-1982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PARQUE CENTRO
Practice Address - Street 2:AVE LAS CUMBRES CARR199
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-5000
Practice Address - Country:US
Practice Address - Phone:787-273-1227
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
23648Medicare ID - Type Unspecified
I48999Medicare UPIN