Provider Demographics
NPI:1538335856
Name:GIRALDO E CEPEDA MD PA
Entity type:Organization
Organization Name:GIRALDO E CEPEDA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIRALDO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:CEPEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-467-6587
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058912208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254831300Medicaid