Healthcare Provider Details

I. General information

NPI: 1154708147
Provider Name (Legal Business Name): JILLIAN MARIE CEPEDA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 08/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 ALTON RD
MIAMI BEACH FL
33140-2948
US

IV. Provider business mailing address

3659 S MIAMI AVE STE 3005
MIAMI FL
33133-4225
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2020
  • Fax:
Mailing address:
  • Phone: 305-674-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOS14822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: