Provider Demographics
NPI:1700503851
Name:CEREZO, MARCIE LYNN RAMOS
Entity Type:Individual
Prefix:
First Name:MARCIE LYNN
Middle Name:RAMOS
Last Name:CEREZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:
Other - Last Name:CEREZO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3110 ORTHELLO WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3760
Mailing Address - Country:US
Mailing Address - Phone:408-332-3382
Mailing Address - Fax:
Practice Address - Street 1:425 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1936
Practice Address - Country:US
Practice Address - Phone:669-245-3429
Practice Address - Fax:408-800-4095
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty