MEDICARE: CECE MOBILE CLINIC LLC

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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1205436318
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CECE MOBILE CLINIC LLC

Provider Business Mailing Address
First Line	:	1323 PEBBLE RIDGE LN
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33411-6612
Country	:	US
Telephone Number	:	561-386-9229
Fax Number	:

Provider Business Practice Location Address
First Line	:	1323 PEBBLE RIDGE LN
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33411-6612
Country	:	US
Telephone Number	:	561-386-9229
Fax Number	:	561-366-7574

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LINDA TATOUTE
Credential	:	APRN
Telephone Number	:	561-386-9229

Provider Enumeration Date	:	10/28/2020
Last Update Date	:	10/28/2020

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