Healthcare Provider Details

I. General information

NPI: 1750389672
Provider Name (Legal Business Name): DAYSTAR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 S FLAMINGO RD
DAVIE FL
33330-1616
US

IV. Provider business mailing address

3800 S FLAMINGO RD
DAVIE FL
33330-1616
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-0167
  • Fax: 954-473-0202
Mailing address:
  • Phone: 954-473-0167
  • Fax: 954-473-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. BEVERLY ANN LUTIRELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-473-0167