Provider Demographics
NPI:1285265082
Name:CEPERO, RICARDO JOSE
Entity type:Individual
Prefix:MR
First Name:RICARDO
Middle Name:JOSE
Last Name:CEPERO
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 1:1116 NW LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-6568
Mailing Address - Country:US
Mailing Address - Phone:580-917-7693
Mailing Address - Fax:
Practice Address - Street 1:1116 NW LAKE AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-6568
Practice Address - Country:US
Practice Address - Phone:580-917-7693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator