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General NPI Number Information
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NPI Number | 1104017946
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Entity Type | Organization
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Legal Business Name | TO YOUR HEALTH OF LAKE COUNTY INC
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 26540 ACE AVE SUITE 108C
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City | LEESBURG
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State | FL
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Zip | 34748-8279
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Country | US
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Telephone | 352-326-5281
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Fax | 352-323-1761
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Provider Business Mailing Address
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Address Line | 26540 ACE AVE SUITE 108C
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City | LEESBURG
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State | FL
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Zip | 34748-8279
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Country | US
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Telephone | 352-326-5281
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Fax | 352-323-1761
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOSEPH L CARRASCO
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Credential | M.D.
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Telephone | 352-326-5281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME70698
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License Number State | FL
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