Provider Demographics
NPI:1891108171
Name:HOUSE, CECILIA (DO)
Entity Type:Individual
Prefix:MISS
First Name:CECILIA
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:CECILIA
Other - Middle Name:
Other - Last Name:BALOCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:12311 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2673
Practice Address - Country:US
Practice Address - Phone:904-262-7211
Practice Address - Fax:904-262-6995
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14875207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine