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General NPI Number Information
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NPI Number | 1457562118
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Entity Type | Individual
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Provider Name | CEDRIC LEON TAYLOR B.A.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7505 NE 2ND AVE
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City | MIAMI
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State | FL
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Zip | 33138-4905
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Country | US
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Telephone | 305-759-5262
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Fax | 305-756-5838
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Provider Business Mailing Address
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Address Line | 5901 SW 62ND TERRACE
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City | MIAMI
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State | FL
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Zip | 33143
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Country | US
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Telephone | 786-256-1439
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Fax | 305-756-5838
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 765163500
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License Number State | FL
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