Individual
ANGELA JEAN CEREZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110001759
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-003
TRICARE/CHAMPUS
VA
01
—
10093799P
OPTIMA HEALTH
VA
05
—
1467462945
—
VA
01
—
PAR
USA MANAGED CARE
VA
Enumeration date
08/08/2006
Last updated
08/20/2012
Update your record
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