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General NPI Number Information
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NPI Number | 1346365533
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Entity Type | Organization
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Legal Business Name | LIFE CARE DIAGNOSTICS
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 04/09/2012
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Provider Practice Location Address
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Address Line | 6320 39TH ST
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City | PINELLAS PARK
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State | FL
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Zip | 33781-6070
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Country | US
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Telephone | 727-522-4433
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Fax | 727-522-3432
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Provider Business Mailing Address
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Address Line | PO BOX 40123
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City | ST PETERSBURG
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State | FL
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Zip | 33743-0123
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Country | US
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Telephone | 727-522-4433
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Fax | 727-522-3432
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Authorized Official
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Title or Position | OWNER
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Name | SANDRA LEE NIELSEN
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Credential |
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Telephone | 727-522-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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