MEDICARE: CEGA STRESS & ESTHETIC CENTER, INC.

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	261Q00000X	Clinic/Center	MM22572	FL

General Provider Information

NPI Number	:	1548409022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEGA STRESS & ESTHETIC CENTER, INC.

Provider Business Mailing Address
First Line	:	3306- W. SPRUCE ST.
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-870-2222
Fax Number	:	813-870-2671

Provider Business Practice Location Address
First Line	:	3306- W. SPRUCE ST.
Second Line	:	SUITE B
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-870-2222
Fax Number	:	813-870-2671

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. SONIA M. CELPA
Credential	:	A.P.
Telephone Number	:	813-870-2222

Provider Enumeration Date	:	02/06/2009
Last Update Date	:	02/06/2009

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