Provider Demographics
NPI:1205257953
Name:CEDENO, DIANA MARIE (OTL)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:CEDENO
Suffix:
Gender:F
Credentials:OTL
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 16
Mailing Address - Street 2:
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739-0016
Mailing Address - Country:US
Mailing Address - Phone:787-233-4055
Mailing Address - Fax:
Practice Address - Street 1:MAGA STREET BO. MONACILLOS
Practice Address - Street 2:CENTRO MEDICO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-233-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1203225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist