MEDICARE: LINDA J CAVALLO LPN,LCHRM,GCM

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1649614223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA J CAVALLO LPN,LCHRM,GCM

Provider Business Mailing Address
First Line	:	5425 MADISON ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-7133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 HOLLYWOOD BLVD STE 566
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6751
Country	:	US
Telephone Number	:	954-347-6487
Fax Number	:

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	04/25/2013

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