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General NPI Number Information
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NPI Number | 1184795189
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Entity Type | Organization
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Legal Business Name | NIKITA HOLDINGS CORP.
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1628 PLEASANT HILL RD
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City | KISSIMMEE
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State | FL
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Zip | 34746-3901
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Country | US
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Telephone | 407-846-1530
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Fax |
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Provider Business Mailing Address
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Address Line | 1628 PLEASANT HILL RD
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City | KISSIMMEE
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State | FL
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Zip | 34746-3901
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Country | US
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Telephone | 407-846-1530
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Fax |
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Authorized Official
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Title or Position | PRESIDENT-OPTICIAN
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Name | MRS. YOLANDA I RODRIGUEZ
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Credential | D.O.
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Telephone | 407-846-1530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO5246
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License Number State | FL
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