Provider Demographics
NPI:1104488618
Name:CEDENO, CARLOS ANANIAS (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANANIAS
Last Name:CEDENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 CALLE JOSE OLIVER APT 509
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2979
Mailing Address - Country:US
Mailing Address - Phone:787-504-5435
Mailing Address - Fax:
Practice Address - Street 1:210 CALLE JOSE OLIVER APT 509
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2979
Practice Address - Country:US
Practice Address - Phone:787-480-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22383208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice