Healthcare Provider Details

I. General information

NPI: 1285806083
Provider Name (Legal Business Name): SONICARE DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 GROVELAND AVE
DELTONA FL
32725-9646
US

IV. Provider business mailing address

2570 GROVELAND AVE
DELTONA FL
32725-9646
US

V. Phone/Fax

Practice location:
  • Phone: 407-221-5665
  • Fax: 407-386-7077
Mailing address:
  • Phone: 407-221-5665
  • Fax: 407-386-7077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License NumberARDMS 99517
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License NumberARDMS 99517
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License NumberARDMS 99517
License Number StateFL

VIII. Authorized Official

Name: MISS LARA BETH BLYSTONE
Title or Position: PRESIDENT
Credential: RDMS, RVT, RDCS
Phone: 407-221-5665