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NPI Code Detail

MEDICARE: NORTH CLEVELAND HEALTHCARE CENTER

MEDICARE: NORTH CLEVELAND HEALTHCARE CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1043664469
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH CLEVELAND HEALTHCARE CENTER
Provider Business Mailing Address
First Line : 13240 N CLEVELAND AVE
Second Line : UNIT # 9
City : NORTH FORT MYERS
State : FL
Zip : 33903-4855
Country : US
Telephone Number : 239-652-3783
Fax Number :
Provider Business Practice Location Address
First Line : 13240 N CLEVELAND AVE
Second Line : UNIT # 9
City : NORTH FORT MYERS
State : FL
Zip : 33903-4855
Country : US
Telephone Number : 239-652-3783
Fax Number :
Authorized Official
Title or Position : OFFICE MANAGER
Name : LAZARO ALFONSO
Credential :
Telephone Number : 239-849-6839
Provider Enumeration Date : 04/21/2016
Last Update Date : 04/21/2016

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Directions to “NORTH CLEVELAND HEALTHCARE CENTER ” Practice Location

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