Healthcare Provider Details

I. General information

NPI: 1336096437
Provider Name (Legal Business Name): ANA GABRIELA CEPERO ROQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E 25TH ST
HIALEAH FL
33013-3817
US

IV. Provider business mailing address

17361 SW 18TH ST
MIRAMAR FL
33029-5530
US

V. Phone/Fax

Practice location:
  • Phone: 305-694-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: