Healthcare Provider Details

I. General information

NPI: 1245017714
Provider Name (Legal Business Name): BENJAMIN ALEXANDER CERA LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S DIXIE HWY STE 4E
CORAL GABLES FL
33146-2232
US

IV. Provider business mailing address

13499 BISCAYNE BLVD APT 1702
NORTH MIAMI FL
33181-2031
US

V. Phone/Fax

Practice location:
  • Phone: 786-885-2285
  • Fax: 786-206-7010
Mailing address:
  • Phone: 754-201-5336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11026788
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: