Healthcare Provider Details

I. General information

NPI: 1144698572
Provider Name (Legal Business Name): LAGLEVA TRANSITIONS MHT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 RUTH VISTA RD
LEXINGTON SC
29073-8628
US

IV. Provider business mailing address

317 RUTH VISTA RD
LEXINGTON SC
29073-8628
US

V. Phone/Fax

Practice location:
  • Phone: 803-714-3665
  • Fax:
Mailing address:
  • Phone: 803-714-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAFAEL L LAGLEVA
Title or Position: OWNER
Credential: MD
Phone: 864-449-1182