Healthcare Provider Details

I. General information

NPI: 1891803433
Provider Name (Legal Business Name): DIVERSIFIED MANAGEMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10817 BLOOMINGDALE AVE
RIVERVIEW FL
33569
US

IV. Provider business mailing address

2727 W DR MARTIN LUTHER KING JR BLVD SUITE 120
TAMPA FL
33607
US

V. Phone/Fax

Practice location:
  • Phone: 813-662-5437
  • Fax: 813-655-3025
Mailing address:
  • Phone: 813-872-6722
  • Fax: 813-872-6341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name: MR. DENNIS ARNALDO HERNANDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 813-872-6722