Provider Demographics
NPI:1578534855
Name:AQUINO CEBOLLERO, IVAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:G
Last Name:AQUINO CEBOLLERO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:URB PASEO LOS ROBLES
Mailing Address - Street 2:EPIFANIO VIDAL 1512
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682
Mailing Address - Country:US
Mailing Address - Phone:787-264-2214
Mailing Address - Fax:787-834-5995
Practice Address - Street 1:CARR 64 KM 3.6 # 5146
Practice Address - Street 2:BO MANI
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682
Practice Address - Country:US
Practice Address - Phone:787-265-2214
Practice Address - Fax:787-834-5995
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2019-08-16
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Provider Licenses
StateLicense IDTaxonomies
PR14475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH95488Medicare UPIN
PR21858Medicare ID - Type Unspecified