Provider Demographics
NPI:1952834566
Name:CERDA, ANTONIO
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:CERDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:CERDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ANTHONY
Mailing Address - Street 1:1133 E RHEA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5125
Mailing Address - Country:US
Mailing Address - Phone:562-322-1677
Mailing Address - Fax:
Practice Address - Street 1:1133 E RHEA ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5125
Practice Address - Country:US
Practice Address - Phone:562-278-6863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator