Provider Demographics
NPI:1821488560
Name:POLIDO, CEZAR SAN JOSE (LPN)
Entity Type:Individual
Prefix:
First Name:CEZAR
Middle Name:SAN JOSE
Last Name:POLIDO
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RHEA AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2950
Mailing Address - Country:US
Mailing Address - Phone:513-889-2466
Mailing Address - Fax:
Practice Address - Street 1:4380 MALSBARY RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5644
Practice Address - Country:US
Practice Address - Phone:513-793-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN093449164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse