MEDICARE: CRYSTAL M CERI RCS

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	246XS1301X	Sonography Specialist/Technologist Cardiovascular	C00116663	FL

General Provider Information

NPI Number	:	1003759564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL M CERI RCS

Provider Business Mailing Address
First Line	:	2962 LEBA LN
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-6516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2962 LEBA LN
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-6516
Country	:	US
Telephone Number	:	407-738-2622
Fax Number	:

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

Provider Enumeration Date	:	04/10/2026
Last Update Date	:	04/10/2026

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