Provider Demographics
NPI:1467779579
Name:GARCIA CEBALLOS, NESTOR SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:SAMUEL
Last Name:GARCIA CEBALLOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S DOUGLAS RD
Mailing Address - Street 2:STE 308
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6134
Mailing Address - Country:US
Mailing Address - Phone:787-232-4480
Mailing Address - Fax:
Practice Address - Street 1:1251 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5532
Practice Address - Country:US
Practice Address - Phone:305-929-6150
Practice Address - Fax:305-634-0600
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN667208D00000X
PR17894208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN667OtherFLORIDA STATE
PR17894OtherPUERTO RICO LICENSE