Healthcare Provider Details

I. General information

NPI: 1730525619
Provider Name (Legal Business Name): JORGE ALFONSO-CEPEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 02/21/2021
Certification Date: 02/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9774 SW 24TH ST
MIAMI FL
33165-7574
US

IV. Provider business mailing address

9774 SW 24TH ST
MIAMI FL
33165-7574
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-2377
  • Fax:
Mailing address:
  • Phone: 786-536-2377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number37387
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number169726
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number27765
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: