Healthcare Provider Details

I. General information

NPI: 1548091010
Provider Name (Legal Business Name): HEERNEY CEPERO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SW 130TH AVE
MIAMI FL
33184-2147
US

IV. Provider business mailing address

1300 SW 130TH AVE
MIAMI FL
33184-2147
US

V. Phone/Fax

Practice location:
  • Phone: 786-690-4914
  • Fax:
Mailing address:
  • Phone: 786-690-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: