Basic Information
| Provider Information | |||||||||
| NPI: | 1922609106 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CEROTTO, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 71602 | ||||||||
| Address2: | |||||||||
| City: | CLIVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503250602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152432057 | ||||||||
| FaxNumber: | 5152445570 | ||||||||
| Practice Location | |||||||||
| Address1: | 1660 CHICAGO AVE STE M9 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925072052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6613124018 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2020 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | ANDOLINO | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO, PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6613124018 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.