Provider Demographics
NPI:1528148467
Name:CEREZO, HECTOR SUMAJIT (MD, INC)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:SUMAJIT
Last Name:CEREZO
Suffix:
Gender:M
Credentials:MD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N JACKSON AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1903
Mailing Address - Country:US
Mailing Address - Phone:408-926-8111
Mailing Address - Fax:408-926-8943
Practice Address - Street 1:125 N JACKSON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1903
Practice Address - Country:US
Practice Address - Phone:408-926-8111
Practice Address - Fax:408-926-8943
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA375022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A375020Medicaid
CA00A375020Medicaid
CAA28389Medicare UPIN
CA00A375020Medicare ID - Type Unspecified