Organization
CERON PEDIATRICS AND INTEGRATIVE MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LOURDES CAROLINA CERON CANAS MD (OWNER)
(904) 891-9498
Entity
Organization
Contact information
Practice address
1539 PARENTAL HOME RD, JACKSONVILLE, FL 32216-3009
(904) 338-0434
Mailing address
13758 CLUB COVE DR, JACKSONVILLE, FL 32225-5430
(904) 891-9498
(904) 425-0821
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019982900
—
FL
Enumeration date
05/17/2018
Last updated
04/12/2019
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