Individual
RUSSELL MITESH CEREJO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
MD462463
PA
2084V0102X
Vascular Neurology Physician
MD462463
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14050329
CAQH
—
Enumeration date
05/08/2010
Last updated
09/30/2020
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