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Individual
MR. MARIO L CEJA
Active
Individual
MR. MARIO L CEJA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G79700
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G79700
—
CA
01
—
GR0066312
MEDI-CAL GROUP #
CA
01
—
W13536B
MEDICARE GROUP #
CA
01
—
WG79700A
MEDICARE PTAN
CA
01
—
ZZZ47481Z
BLUE SHIELD ZZZ #
CA
Enumeration date
05/03/2006
Last updated
10/01/2021
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