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General NPI Number Information
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NPI Number | 1366194649
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Entity Type | Organization
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Legal Business Name | FOREVER YOUNG DIAGNOSTICS
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 02/18/2022
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Provider Practice Location Address
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Address Line | 110 LITHIA PINECREST RD STE H
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City | BRANDON
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State | FL
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Zip | 33511-5300
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Country | US
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Telephone | 813-857-8556
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Fax |
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Provider Business Mailing Address
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Address Line | 3848 SUN CITY CENTER BLVD # 104-49
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City | SUN CITY CENTER
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State | FL
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Zip | 33573-6843
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Country | US
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Telephone | 813-857-8556
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Fax |
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Authorized Official
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Title or Position | ADMIN
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Name | ZARANDA YOUNG
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Credential |
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Telephone | 813-857-8556
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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