MEDICARE: CEVARES MEDICAL CARE, LLC

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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023606803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEVARES MEDICAL CARE, LLC

Provider Business Mailing Address
First Line	:	757 NW 27TH AVE STE 201
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3012
Country	:	US
Telephone Number	:	786-472-0230
Fax Number	:	786-408-6242

Provider Business Practice Location Address
First Line	:	757 NW 27TH AVE STE 201
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3012
Country	:	US
Telephone Number	:	786-472-0230
Fax Number	:	786-408-6242

Authorized Official
Title or Position	:	AO
Name	:	JULIO CESAR CEVARES ALCANTARA
Credential	:
Telephone Number	:	786-472-0230

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	06/30/2022

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