Provider Demographics
NPI:1831179795
Name:CEPERO AYENDE, CARLOS A (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:CEPERO AYENDE
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 1326
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1326
Mailing Address - Country:US
Mailing Address - Phone:787-735-7575
Mailing Address - Fax:787-735-3010
Practice Address - Street 1:URB. VILLA ROSALES
Practice Address - Street 2:DR. TROYER A2
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-7575
Practice Address - Fax:787-735-3010
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE59286Medicare UPIN
PR0082979Medicare ID - Type Unspecified