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General NPI Number Information
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NPI Number | 1215170378
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Entity Type | Organization
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Legal Business Name | LAGNOS LLC
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Dates
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Enumeration Date | 04/19/2009
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Last Update Date | 04/19/2009
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Provider Practice Location Address
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Address Line | 2400 S HWY 27 SUITE 4309
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City | CLERMONT
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State | FL
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Zip | 34711-6816
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Country | US
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Telephone | 352-353-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 S HWY 27 SUITE 4309
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City | CLERMONT
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State | FL
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Zip | 34711-6816
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Country | US
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Telephone | 352-353-0557
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Fax |
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Authorized Official
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Title or Position | MEMBER/ SOLE OWNER
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Name | DIMITRIOS HATZIVLASSIOU
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Credential | MD
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Telephone | 352-353-0557
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME84252
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License Number State | FL
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