Healthcare Provider Details

I. General information

NPI: 1447177241
Provider Name (Legal Business Name): PRIMEDRAW MOBILE LAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4549 BIG ISLAND DR
KISSIMMEE FL
34746-3495
US

IV. Provider business mailing address

4549 BIG ISLAND DR
KISSIMMEE FL
34746-3495
US

V. Phone/Fax

Practice location:
  • Phone: 689-264-8546
  • Fax:
Mailing address:
  • Phone: 689-264-8546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ZAILYS VIZCARRONDO ISAAC
Title or Position: OWNER
Credential: RN
Phone: 689-264-8546