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General NPI Number Information
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NPI Number | 1215347299
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Entity Type | Organization
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Legal Business Name | MAYA DIAGNOSTIC IMAGING, LLC
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Dates
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Enumeration Date | 04/30/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 294 PATTERSON RD STE B
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City | HAINES CITY
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State | FL
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Zip | 33844-6263
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Country | US
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Telephone | 863-438-7465
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Fax | 863-438-7466
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Provider Business Mailing Address
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Address Line | 3241 HIDDEN LAKE DR
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City | WINTER GARDEN
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State | FL
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Zip | 34787-5427
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Country | US
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Telephone | 407-342-5842
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DONALD JEFFERY SAPP
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Credential | PHD
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Telephone | 407-342-5842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | FL
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