Provider Demographics
NPI:1871696799
Name:CEDENO, WILMA E (MD)
Entity type:Individual
Prefix:
First Name:WILMA
Middle Name:E
Last Name:CEDENO
Suffix:
Gender:F
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:PMB 12
Mailing Address - Street 2:P.O. BOX 6022
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-6022
Mailing Address - Country:US
Mailing Address - Phone:787-360-4600
Mailing Address - Fax:787-754-1059
Practice Address - Street 1:1700 CALLE SANTA AGUEDA
Practice Address - Street 2:URB. SAN GERARDO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4312
Practice Address - Country:US
Practice Address - Phone:787-754-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13658208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH55666Medicare UPIN