Healthcare Provider Details

I. General information

NPI: 1942534672
Provider Name (Legal Business Name): SRA VENTURES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

572 OCOEE COMMERCE PARKWAY
OCOEE FL
34761
US

IV. Provider business mailing address

501 S LINCOLN AVE 15
CLEARWATER FL
33756-5945
US

V. Phone/Fax

Practice location:
  • Phone: 407-228-6635
  • Fax:
Mailing address:
  • Phone: 727-446-6760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY ABOUD
Title or Position: C.E.O.
Credential: D.O.
Phone: 407-228-6635