Organization
BLUESHINE MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE GUSTAVO CEVALLOS MD (PROVIDER)
(305) 790-6544
Entity
Organization
Contact information
Practice address
140 SANTA BARBARA BLVD STE 121, CAPE CORAL, FL 33991-2160
(305) 790-6544
Mailing address
205 NW 15TH PL, CAPE CORAL, FL 33993-7747
(561) 762-1660
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
09/23/2024
Last updated
09/23/2024
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