Provider Demographics
NPI:1831562198
Name:CERRITOS, WENDY LORRAINE
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:LORRAINE
Last Name:CERRITOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 OAKLAND STREET
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805
Mailing Address - Country:US
Mailing Address - Phone:804-366-4748
Mailing Address - Fax:
Practice Address - Street 1:3208 SYLVANIA PL
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-7249
Practice Address - Country:US
Practice Address - Phone:804-366-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide