MEDICARE: MR. CEDRIC LEON TAYLOR B.A.

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	171M00000X	Case Manager/Care Coordinator	765163500	FL

General Provider Information

NPI Number	:	1457562118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CEDRIC LEON TAYLOR B.A.

Provider Business Mailing Address
First Line	:	5901 SW 62ND TERRACE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33143
Country	:	US
Telephone Number	:	786-256-1439
Fax Number	:	305-756-5838

Provider Business Practice Location Address
First Line	:	7505 NE 2ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33138-4905
Country	:	US
Telephone Number	:	305-759-5262
Fax Number	:	305-756-5838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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