Healthcare Provider Details

I. General information

NPI: 1316856644
Provider Name (Legal Business Name): ANDERSON CEPERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 SW 37TH AVE APT 712
MIAMI FL
33135-4292
US

IV. Provider business mailing address

987 SW 37TH AVE APT 712
MIAMI FL
33135-4292
US

V. Phone/Fax

Practice location:
  • Phone: 786-560-8434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2843120
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: