Provider Demographics
NPI:1528490067
Name:CERENO, MARYLINE
Entity type:Individual
Prefix:
First Name:MARYLINE
Middle Name:
Last Name:CERENO
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 1:2317 FOUR SEASONS CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1971
Mailing Address - Country:US
Mailing Address - Phone:408-644-1902
Mailing Address - Fax:
Practice Address - Street 1:2317 FOUR SEASONS CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1971
Practice Address - Country:US
Practice Address - Phone:408-644-1902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA 68777126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant