Healthcare Provider Details

I. General information

NPI: 1952366502
Provider Name (Legal Business Name): CESAR E. CEBALLOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 SW 87TH AVE SUITE A110
MIAMI FL
33173-3570
US

IV. Provider business mailing address

7800 SW 87TH AVE SUITE A110
MIAMI FL
33173-3570
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-2828
  • Fax: 305-596-6446
Mailing address:
  • Phone: 305-596-2828
  • Fax: 305-596-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME72645
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME72645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: