Provider Demographics
NPI:1528955481
Name:CERDA IBANEZ, JESSICA VALERIA
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:VALERIA
Last Name:CERDA IBANEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 S HIAWASSEE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6317
Mailing Address - Country:US
Mailing Address - Phone:407-286-4031
Mailing Address - Fax:
Practice Address - Street 1:3200 S HIAWASSEE RD STE 203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6317
Practice Address - Country:US
Practice Address - Phone:407-286-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24-320647106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician