Basic Information
Provider Information | |||||||||
NPI: | 1326237744 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CERENO | ||||||||
FirstName: | AURORA | ||||||||
MiddleName: | YANGA | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | YANGA | ||||||||
OtherFirstName: | AURORA | ||||||||
OtherMiddleName: | TORRES | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PT | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3290 NORTH RIDGE RD. | ||||||||
Address2: | SUITE 290 EXECUTIVE CENTER II | ||||||||
City: | ELLICOTT CITY | ||||||||
State: | MD | ||||||||
PostalCode: | 21043 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4107509006 | ||||||||
FaxNumber: | 4107500787 | ||||||||
Practice Location | |||||||||
Address1: | 3201 W. COMMERCIAL BLVD., | ||||||||
Address2: | STE #116 | ||||||||
City: | FT. LAUDERDALE | ||||||||
State: | FL | ||||||||
PostalCode: | 333093440 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8008868108 | ||||||||
FaxNumber: | 8003700755 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/22/2007 | ||||||||
LastUpdateDate: | 10/22/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   | FL | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.