Provider Demographics
NPI:1952644312
Name:CERDA, MARTIN ALEJANDRO (DO)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:ALEJANDRO
Last Name:CERDA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20414 N 27TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-3254
Mailing Address - Country:US
Mailing Address - Phone:623-879-6000
Mailing Address - Fax:623-516-2000
Practice Address - Street 1:20414 N 27TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-3254
Practice Address - Country:US
Practice Address - Phone:623-879-6000
Practice Address - Fax:623-516-2000
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLOS13804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016836200Medicaid