Provider Demographics
NPI:1578455564
Name:CEPERO, JOSHUA JESUS
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:JESUS
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 1:480 E 176TH ST APT 415
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-6298
Mailing Address - Country:US
Mailing Address - Phone:917-569-4450
Mailing Address - Fax:
Practice Address - Street 1:507 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-5101
Practice Address - Country:US
Practice Address - Phone:212-234-1660
Practice Address - Fax:212-234-1660
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352651-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse