Healthcare Provider Details

I. General information

NPI: 1780772822
Provider Name (Legal Business Name): CICERO ORTHO-MED CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 NW 7TH ST
MIAMI FL
33126-2306
US

IV. Provider business mailing address

4567 NW 7TH ST
MIAMI FL
33126-2306
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-4002
  • Fax: 305-448-1956
Mailing address:
  • Phone: 305-448-4002
  • Fax: 305-448-1956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANA CICERO OCEGUERA
Title or Position: PRESIDENT
Credential:
Phone: 305-448-4002