Healthcare Provider Details

I. General information

NPI: 1346737749
Provider Name (Legal Business Name): CEDA ORTHOPEDIC GROUP, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 NW 57TH AVENUE, STE. 202
MIAMI FL
33126
US

IV. Provider business mailing address

P.O. BOX 26-1750
MIAMI FL
33126
US

V. Phone/Fax

Practice location:
  • Phone: 305-669-1808
  • Fax: 305-888-5299
Mailing address:
  • Phone: 305-669-1808
  • Fax: 305-888-5299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberME-31217
License Number StateFL

VIII. Authorized Official

Name: MARK ANTHONY CERECEDA
Title or Position: OWNER/CEO
Credential: DC
Phone: 305-888-5280