Provider Demographics
NPI:1639199599
Name:CEDENO, JESSICA -
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:-
Last Name:CEDENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:-
Other - Last Name:CEDENO RICHIEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1948 CALLE JOSE FIDALGO DIAZ
Mailing Address - Street 2:COND ALTURAS DE CALDAS APT 141
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5326
Mailing Address - Country:US
Mailing Address - Phone:787-758-9394
Mailing Address - Fax:
Practice Address - Street 1:715 AVE PONCE DE LEON
Practice Address - Street 2:PDA 37 1/2 HOSP AUXILIO MUTUO TORRE MEDICA 502
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-5032
Practice Address - Country:US
Practice Address - Phone:787-296-0870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14116207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology