Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PO4084 | FL |
Y | 222Z00000X | Podiatrist | PO4084 | FL |
NPI | 1023461480 |
---|---|
Provider Name | Dr. Cynthia Correa-Cedeno |
First Address | Jacksonville, FL 32244-5597 |
Second Address | Jacksonville, FL 32250-1695 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2016 |
Last Update Date | 12/11/2019 |