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General NPI Number Information
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NPI Number | 1366962037
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Entity Type | Organization
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Legal Business Name | BRAINTECH DIAGNOSTICS LLC
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Dates
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Enumeration Date | 06/23/2017
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Last Update Date | 06/23/2017
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Provider Practice Location Address
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Address Line | 515 E LAS OLAS BLVD STE 120
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-4261
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Country | US
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Telephone | 954-304-5483
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Fax |
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Provider Business Mailing Address
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Address Line | 7385 NW 68TH AVE
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City | PARKLAND
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State | FL
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Zip | 33067-3914
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Country | US
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Telephone | 954-304-5483
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALEX LUNDY
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Credential |
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Telephone | 954-304-5483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | FL
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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 | FL
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