LAKEWOOD CCL LLC NPI 1922575802

NPI Information

  • NPI: 1922575802
  • Provider Name: LAKEWOOD CCL, LLC
  • Classification: Clinic/Center - 261QM1300X
  • Specialization: Multi-Specialty
  • Entity Type: Organization
  • CLIA Number: 10D2167678
  • Address: 5571 E SR 44 STE 501
    WILDWOOD, FL
    ZIP 34785
  • Phone: (352) 643-9070

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NPI Details

LAKEWOOD CCL, LLC is a multi-specialty clinic center in Wildwood, FL. LAKEWOOD CCL, LLC NPI is 1922575802. The provider is registered as an organization entity type.

The provider's business location address is:

5571 E SR 44 STE 501
WILDWOOD, FL
ZIP 34785-282
Phone: (352) 643-9070
Fax: (352) 571-6787

The provider's authorized official is Jose A Rivera .
The authorized official title is Administrator and has the following contact phone number (352) 643-9070.

The CLIA number assigned to this NPI record is 10D2167678 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/29/2018 and was last updated on 10/29/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM1300XClinic/CenterMulti-SpecialtyYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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