Provider Demographics
NPI:1366095002
Name:CEREZO, VANESSA DULAY
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:DULAY
Last Name:CEREZO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-507 PAPIPI RD
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2336
Mailing Address - Country:US
Mailing Address - Phone:808-351-3042
Mailing Address - Fax:
Practice Address - Street 1:91-507 PAPIPI RD
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2336
Practice Address - Country:US
Practice Address - Phone:808-351-3042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty