Provider Demographics
NPI:1710020409
Name:HERNANDEZ CEREZO, RUTILIO (MD)
Entity Type:Individual
Prefix:DR
First Name:RUTILIO
Middle Name:
Last Name:HERNANDEZ CEREZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3613
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3613
Mailing Address - Country:US
Mailing Address - Phone:787-830-2705
Mailing Address - Fax:787-830-3059
Practice Address - Street 1:AVE AGUSTIN RAMOS CALERO
Practice Address - Street 2:KM 1.4
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-830-2705
Practice Address - Fax:787-830-3059
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12007208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH42472Medicare UPIN