Organization
ST BERNADETTE'S CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE CERON-FUENTES M.D. (PRESIDENT)
(352) 593-4242
Entity
Organization
Contact information
Practice address
5448 LEGEND HILLS LN, BROOKSVILLE, FL 34609-9502
(352) 593-4242
Mailing address
PO BOX 15669, BROOKSVILLE, FL 34604-0122
(352) 593-4242
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
ME95797
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2775247
—
FL
Enumeration date
09/21/2011
Last updated
09/21/2011
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