Provider Demographics
NPI:1528218708
Name:GIBEL CEDENO LLC
Entity Type:Organization
Organization Name:GIBEL CEDENO LLC
Other - Org Name:GIBEL CEDENO LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GIBEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CEDENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-455-4284
Mailing Address - Street 1:777 E 25TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3825
Mailing Address - Country:US
Mailing Address - Phone:305-455-4284
Mailing Address - Fax:
Practice Address - Street 1:777 E 25TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3825
Practice Address - Country:US
Practice Address - Phone:305-455-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty