Provider Demographics
NPI:1790558880
Name:CERRONE FAMILY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CERRONE FAMILY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUTREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-249-1369
Mailing Address - Street 1:104 QUAIL TRL STE B
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-7197
Mailing Address - Country:US
Mailing Address - Phone:505-926-9700
Mailing Address - Fax:505-788-5660
Practice Address - Street 1:104 QUAIL TRL STE B
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-7197
Practice Address - Country:US
Practice Address - Phone:505-926-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty