Provider Demographics
NPI:1952031635
Name:CERDA SANTOS, JEAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:C
Last Name:CERDA SANTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:295 CALLE DIMAS PAGAN
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-1217
Mailing Address - Country:US
Mailing Address - Phone:787-477-7755
Mailing Address - Fax:
Practice Address - Street 1:CARR. 3 KM142.6
Practice Address - Street 2:INSTITUCION CORRECCIONAL GUAYAM
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00078
Practice Address - Country:US
Practice Address - Phone:787-520-6110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR001278-PA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant