Healthcare Provider Details

I. General information

NPI: 1376172841
Provider Name (Legal Business Name): NATALIE CEBALLOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N FLAMINGO RD STE 411
PEMBROKE PINES FL
33028-1012
US

IV. Provider business mailing address

2900 N COMMERCE PKWY
MIRAMAR FL
33025-3959
US

V. Phone/Fax

Practice location:
  • Phone: 954-844-1617
  • Fax:
Mailing address:
  • Phone: 954-276-5603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number183364
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: