Provider Demographics
NPI:1295746618
Name:CARRIEDO-CENICEROS, MARIA TERESA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:TERESA
Last Name:CARRIEDO-CENICEROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 BEYER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-2007
Mailing Address - Country:US
Mailing Address - Phone:619-428-4463
Mailing Address - Fax:619-428-2625
Practice Address - Street 1:1136 D AVENUE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950
Practice Address - Country:US
Practice Address - Phone:619-336-2300
Practice Address - Fax:619-336-2323
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FHC70267FOtherMEDI-CAL
H99270Medicare UPIN
W5740AMedicare ID - Type Unspecified