Provider Demographics
NPI:1467416982
Name:CEPERO, BELKIS RAQUEL (MD)
Entity Type:Individual
Prefix:
First Name:BELKIS
Middle Name:RAQUEL
Last Name:CEPERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BELKIS
Other - Middle Name:RAQUEL
Other - Last Name:CEPERO-ZARAGOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3488 DEPEW AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-7015
Mailing Address - Country:US
Mailing Address - Phone:941-764-7923
Mailing Address - Fax:941-764-7927
Practice Address - Street 1:3488 DEPEW AVE
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-7015
Practice Address - Country:US
Practice Address - Phone:941-764-7923
Practice Address - Fax:941-764-7927
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2016-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99946208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000402000Medicaid