Basic Information
| Provider Information | |||||||||
| NPI: | 1821488560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLIDO | ||||||||
| FirstName: | CEZAR | ||||||||
| MiddleName: | SAN JOSE | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 RHEA AVE | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450132950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138892466 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4380 MALSBARY RD | ||||||||
| Address2: | |||||||||
| City: | BLUE ASH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452425644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137936444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2015 | ||||||||
| LastUpdateDate: | 02/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | PN093449 | OH | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.