Provider Demographics
NPI:1255075792
Name:CEBALLOS, ERIC JAVIER (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JAVIER
Last Name: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 1:500 NW 124TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1223
Mailing Address - Country:US
Mailing Address - Phone:786-423-5930
Mailing Address - Fax:
Practice Address - Street 1:500 NW 124TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1223
Practice Address - Country:US
Practice Address - Phone:786-423-5930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program