Provider Demographics
NPI:1205085727
Name:CERMENO, SELENA (DC)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:
Last Name:CERMENO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 SHADOW SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1751
Mailing Address - Country:US
Mailing Address - Phone:408-482-7775
Mailing Address - Fax:831-771-1772
Practice Address - Street 1:3028 SHADOW SPRINGS PL
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1751
Practice Address - Country:US
Practice Address - Phone:408-482-7775
Practice Address - Fax:831-771-1772
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor