Provider Demographics
NPI:1619233509
Name:CEPERO PEDIATRICS, P.A.
Entity Type:Organization
Organization Name:CEPERO PEDIATRICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BELKIS
Authorized Official - Middle Name:RAQUEL
Authorized Official - Last Name:CEPERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-764-7923
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99946208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305872700Medicaid
FL010456700Medicaid
FL000402000Medicaid