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General NPI Number Information
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NPI Number | 1144560889
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC VASCULAR TESTING, LLC
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Dates
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Enumeration Date | 02/17/2013
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Last Update Date | 02/17/2013
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Provider Practice Location Address
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Address Line | 21614 BELLA TERRA BLVD
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City | ESTERO
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State | FL
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Zip | 33928-7336
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Country | US
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Telephone | 239-204-1371
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Fax |
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Provider Business Mailing Address
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Address Line | 21614 BELLA TERRA BLVD
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City | ESTERO
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State | FL
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Zip | 33928-7336
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Country | US
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Telephone | 239-204-1371
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Fax |
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Authorized Official
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Title or Position | OWNER/VASCULAR TECHNOLOGIST
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Name | MR. JEFFREY EDWARD SCHAFER
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Credential | RVT
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Telephone | 239-204-1371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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