Provider Demographics
NPI:1164608824
Name:CEPEDA-GOODWIN, MARLENE ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:ELIZABETH
Last Name:CEPEDA-GOODWIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 NW 13TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2305
Mailing Address - Country:US
Mailing Address - Phone:561-955-2141
Mailing Address - Fax:561-955-2115
Practice Address - Street 1:701 NW 13TH ST FL 3
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2305
Practice Address - Country:US
Practice Address - Phone:561-955-2141
Practice Address - Fax:561-955-2115
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104445363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical