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Organization
LAKEWOOD CCL, LLC
Active
Organization
LAKEWOOD CCL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSE A RIVERA (ADMINISTRATOR)
(352) 643-9070
Entity
Organization
Contact information
Practice address
5571 E SR 44 STE 501, WILDWOOD, FL 34785-8282
(352) 643-9070
(352) 571-6787
Mailing address
5571 E SR 44 STE 501, WILDWOOD, FL 34785-8282
(352) 643-9070
(352) 571-6787
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/29/2018
Last updated
10/29/2018
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