Provider Demographics
NPI:1689820359
Name:DE ANDINO DE JESUS, CECILIANA (MD)
Entity Type:Individual
Prefix:
First Name:CECILIANA
Middle Name:
Last Name:DE ANDINO DE JESUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CECILIANA
Other - Middle Name:
Other - Last Name:DE ANDINO DE JESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:UNIVERSITY DISTRICT HOSPITAL
Mailing Address - Street 2:MEDICAL CENTER UDH 2 PO 2116
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-2116
Mailing Address - Country:US
Mailing Address - Phone:787-754-0101
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY DISTRICT HOSPITAL
Practice Address - Street 2:MEDICAL CENTER UDH 2 PO 2116
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00922-2116
Practice Address - Country:US
Practice Address - Phone:787-754-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19352208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology