MEDICARE: CDC RESEARCH INSTITUTE,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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1922769561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CDC RESEARCH INSTITUTE,LLC

Provider Business Mailing Address
First Line	:	1700 SE HILLMOOR DR STE 305
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7536
Country	:	US
Telephone Number	:	772-807-1636
Fax Number	:	772-807-1636

Provider Business Practice Location Address
First Line	:	1700 SE HILLMOOR DR STE 305
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-7536
Country	:	US
Telephone Number	:	772-807-1636
Fax Number	:	772-807-1636

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VIVIAN SALINAS
Credential	:	APRN
Telephone Number	:	305-812-4329

Provider Enumeration Date	:	01/05/2022
Last Update Date	:	01/05/2022

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