Provider Demographics
NPI:1245017714
Name:CERA LOPEZ, BENJAMIN ALEXANDER
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALEXANDER
Last Name:CERA LOPEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13499 BISCAYNE BLVD APT 1702
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2031
Mailing Address - Country:US
Mailing Address - Phone:754-201-5336
Mailing Address - Fax:
Practice Address - Street 1:13499 BISCAYNE BLVD APT 1702
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2031
Practice Address - Country:US
Practice Address - Phone:754-201-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11026788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily