Provider Demographics
NPI:1134981954
Name:CERRILLO, DANIEL
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:CERRILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GERMAN GEDOVIUS #10489, INT 306, ZONA URBANA RIO
Mailing Address - Street 2:
Mailing Address - City:TIJUANA
Mailing Address - State:BAJJA CALIFORNIA
Mailing Address - Zip Code:22010
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GERMAN GEDOVIUS #10489, INT 306, ZONA URBANA RIO
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:BAJJA CALIFORNIA
Practice Address - Zip Code:22010
Practice Address - Country:MX
Practice Address - Phone:664-188-1476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZAEIE143751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty