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General NPI Number Information
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NPI Number | 1356326409
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Entity Type | Organization
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Legal Business Name | VISTA CLINICAL DIAGNOSTICS LLC
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 4290 S HWY 27 SUITE 201
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City | CLERMONT
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State | FL
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Zip | 34711-8066
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Country | US
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Telephone | 352-536-9270
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Fax | 352-536-9279
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Provider Business Mailing Address
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Address Line | 4290 S HWY 27 SUITE 201
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City | CLERMONT
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State | FL
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Zip | 34711-8066
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Country | US
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Telephone | 352-536-9270
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Fax | 352-536-9279
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVIAN S SANTANA
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Credential |
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Telephone | 352-536-9270
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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 | 800027066
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License Number State | FL
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