Healthcare Provider Details

I. General information

NPI: 1407072077
Provider Name (Legal Business Name): MAURICIO CERPAS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9380 SW 72ND ST SUITE B-120
MIAMI FL
33173-3276
US

IV. Provider business mailing address

8335 SW 152ND AVE B-408
MIAMI FL
33193-4081
US

V. Phone/Fax

Practice location:
  • Phone: 305-984-5416
  • Fax:
Mailing address:
  • Phone: 305-752-2551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: