Healthcare Provider Details

I. General information

NPI: 1396557690
Provider Name (Legal Business Name): TIFFANY CERDA DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3659 S MIAMI AVE STE 3008
MIAMI FL
33133-4225
US

IV. Provider business mailing address

93 VIA DE CASAS NORTE
BOYNTON BEACH FL
33426-8815
US

V. Phone/Fax

Practice location:
  • Phone: 305-859-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY E CERDA
Title or Position: DOCTOR
Credential: DPM
Phone: 561-707-4772