Healthcare Provider Details

I. General information

NPI: 1720100225
Provider Name (Legal Business Name): MARK ANTHONY CERECEDA D.C., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 11/02/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 N KROME AVE
HOMESTEAD FL
33030-6018
US

IV. Provider business mailing address

717 PONCE DE LEON BLVD SUITE # 216
CORAL GABLES FL
33134-2060
US

V. Phone/Fax

Practice location:
  • Phone: 305-246-0056
  • Fax: 305-246-0093
Mailing address:
  • Phone: 305-441-9601
  • Fax: 305-441-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH 6867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: