Healthcare Provider Details

I. General information

NPI: 1720948433
Provider Name (Legal Business Name): LUIS ENILBER CESPEDES SR. APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

3650 NW 36TH ST APT 610
MIAMI FL
33142-4942
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-4400
  • Fax:
Mailing address:
  • Phone: 702-861-1869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11043608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: