Basic Information
| Provider Information | |||||||||
| NPI: | 1770625931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CERRUTO | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7111 FAIRWAY DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | PALM BEACH GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334184204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003306565 | ||||||||
| FaxNumber: | 5617127349 | ||||||||
| Practice Location | |||||||||
| Address1: | 8150 CHANCELLOR DR | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328097691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003957284 | ||||||||
| FaxNumber: | 4078562312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 10/18/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | ME97895 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0102X | ME97895 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.