Healthcare Provider Details

I. General information

NPI: 1558924894
Provider Name (Legal Business Name): MEDIZEN HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 BAYSHORE BLVD APT 802
TAMPA FL
33629-7362
US

IV. Provider business mailing address

2611 BAYSHORE BLVD APT 802
TAMPA FL
33629-7362
US

V. Phone/Fax

Practice location:
  • Phone: 310-869-7555
  • Fax:
Mailing address:
  • Phone: 310-869-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LIEU-CHI HARKINS
Title or Position: CEO/PRESIDENT
Credential: MD
Phone: 310-869-7555