Provider Demographics
NPI:1386798221
Name:CEPEDA, GIRALDO ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:GIRALDO
Middle Name:ENRIQUE
Last Name:CEPEDA
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 1:1221 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4707
Mailing Address - Country:US
Mailing Address - Phone:772-467-6587
Mailing Address - Fax:772-466-4297
Practice Address - Street 1:1221 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4707
Practice Address - Country:US
Practice Address - Phone:772-467-6587
Practice Address - Fax:772-466-4297
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058912208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3729072900Medicaid
FL3729072900Medicaid