Organization
JOSE G CEVALLOS MD-PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE GUSTAVO CEVALLOS MD (PRESIDENT)
(305) 790-6544
Entity
Organization
Contact information
Practice address
15643 CYPRESS PARK DR, WELLINGTON, FL 33414-6341
(305) 790-6544
Mailing address
15643 CYPRESS PARK DR, WELLINGTON, FL 33414-6341
(305) 790-6544
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
ME114288
FL
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
011046600
—
FL
Enumeration date
09/01/2016
Last updated
12/08/2023
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