Provider Demographics
NPI:1548777543
Name:CEDA ORTHOPEDICS & INTERVENTIONAL MEDICINE
Entity Type:Organization
Organization Name:CEDA ORTHOPEDICS & INTERVENTIONAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CERECEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-888-5280
Mailing Address - Street 1:P.O. BOX 1750
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:305-363-1366
Mailing Address - Fax:305-888-5299
Practice Address - Street 1:10974 SW 184TH STREET
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-363-1366
Practice Address - Fax:305-888-5299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7764111NX0800X
208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty