=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306986310
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISO DIAGNOSTICS TESTING INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 02/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1920 E HALLANDALE BEACH BLVD STE 901
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-4726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-476-2213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 452186
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33345-2186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-476-2213
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DAVID WATTS BARUCH
-----------------------------------------------------
Credential | BS.C.MEDICAL SCIENCE
-----------------------------------------------------
Telephone | 800-476-2213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | HCC6529
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------