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General NPI Number Information
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NPI Number | 1336767680
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Entity Type | Organization
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Legal Business Name | CEREUS OSTEOPATHIC MEDICINE LLC
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Dates
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Enumeration Date | 07/13/2020
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Last Update Date | 07/13/2020
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Provider Practice Location Address
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Address Line | 870 N COCOA BLVD STE A
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City | COCOA
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State | FL
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Zip | 32922-7588
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Country | US
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Telephone | 321-866-8847
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Fax | 954-351-8349
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Provider Business Mailing Address
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Address Line | 870 N COCOA BLVD STE A
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City | COCOA
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State | FL
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Zip | 32922-7588
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Country | US
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Telephone | 321-866-8847
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Fax | 954-351-8349
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. AMY JOY SELWACH
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Credential | DO MBA
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Telephone | 954-257-4262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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