Healthcare Provider Details

I. General information

NPI: 1265309439
Provider Name (Legal Business Name): CECILIA GORDILLO CASERO LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 PALM RIVER RD STE 300
TAMPA FL
33619-4577
US

IV. Provider business mailing address

10740 PALM RIVER RD STE 300
TAMPA FL
33619-4577
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7585
  • Fax: 813-844-5785
Mailing address:
  • Phone: 813-660-6452
  • Fax: 813-844-5785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberTGC673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: