Individual
ANGELA JEAN CEREZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
600 CRAWFORD ST, SUITE 300, PORTSMOUTH, VA 23704-3820
(757) 397-6344
(757) 606-1185
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 397-6344
(757) 606-1185
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
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