Healthcare Provider Details

I. General information

NPI: 1255048252
Provider Name (Legal Business Name): GINGER MARIELA CEDENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 NW 19TH PL
CAPE CORAL FL
33993-8344
US

IV. Provider business mailing address

2912 NW 19TH PL
CAPE CORAL FL
33993-8344
US

V. Phone/Fax

Practice location:
  • Phone: 239-265-5778
  • Fax:
Mailing address:
  • Phone: 239-265-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number12689285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: