Provider Demographics
NPI:1184625543
Name:ATIL, PLARIDEL CERNA (MD)
Entity type:Individual
Prefix:DR
First Name:PLARIDEL
Middle Name:CERNA
Last Name:ATIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-1433
Mailing Address - Country:US
Mailing Address - Phone:626-335-0208
Mailing Address - Fax:626-857-9418
Practice Address - Street 1:412 W CARROLL AVE STE 202
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741
Practice Address - Country:US
Practice Address - Phone:626-335-0208
Practice Address - Fax:626-857-9418
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A251670Medicaid
CA00A251670Medicaid
CAW13020Medicare ID - Type Unspecified