Healthcare Provider Details

I. General information

NPI: 1568476331
Provider Name (Legal Business Name): PALM BEACH CARDIOVASCULAR PANEL READINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 UNIVERSITY BLVD SUITE 200
JUPITER FL
33458-2778
US

IV. Provider business mailing address

PO BOX 8063
JUPITER FL
33468-8063
US

V. Phone/Fax

Practice location:
  • Phone: 561-627-2210
  • Fax: 561-627-5850
Mailing address:
  • Phone: 561-747-5755
  • Fax: 561-743-3359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE L WAITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 561-627-2210