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General NPI Number Information
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NPI Number | 1306899315
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Entity Type | Organization
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Legal Business Name | LEISURE SOLUTIONS, INC.
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 13940 N US HIGHWAY 441 SUITE 905
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City | LADY LAKE
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State | FL
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Zip | 32159-8908
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Country | US
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Telephone | 352-751-0235
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Fax | 352-751-6777
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Provider Business Mailing Address
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Address Line | 13940 N US HIGHWAY 441 SUITE 905
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City | LADY LAKE
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State | FL
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Zip | 32159-8908
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Country | US
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Telephone | 352-751-0235
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Fax | 352-751-6777
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JACQUES RAPHAEL
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Credential |
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Telephone | 352-751-0235
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | HCC5021
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License Number State | FL
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