Healthcare Provider Details

I. General information

NPI: 1821883968
Provider Name (Legal Business Name): GEISSEL CEPERO ESQUIVEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 SW ALEDO LN
PORT SAINT LUCIE FL
34953-4143
US

IV. Provider business mailing address

1522 SW ALEDO LN
PORT SAINT LUCIE FL
34953-4143
US

V. Phone/Fax

Practice location:
  • Phone: 561-528-0833
  • Fax:
Mailing address:
  • Phone: 561-528-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24390335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: