Provider Demographics
NPI:1952404451
Name:CECILIO, VERA D (MD)
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:D
Last Name:CECILIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7345 MEDICAL CENTER DR
Mailing Address - Street 2:STE 510
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1967
Mailing Address - Country:US
Mailing Address - Phone:818-888-7878
Mailing Address - Fax:818-888-5200
Practice Address - Street 1:16661 VENTURA BLVD STE 405
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1960
Practice Address - Country:US
Practice Address - Phone:818-986-1200
Practice Address - Fax:818-986-3011
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA26195207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A83339Medicare UPIN
00A26195Medicare ID - Type Unspecified