Healthcare Provider Details

I. General information

NPI: 1396033593
Provider Name (Legal Business Name): NATIVE AMERICAN DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2011
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2771 SW 81ST WAY
DAVIE FL
33328-1617
US

IV. Provider business mailing address

2771 SW 81ST WAY
DAVIE FL
33328-1617
US

V. Phone/Fax

Practice location:
  • Phone: 305-555-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: ERNEST TIGER
Title or Position: COO
Credential:
Phone: 305-555-1212