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General NPI Number Information
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NPI Number | 1386259323
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Entity Type | Organization
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Legal Business Name | BRANDON STEM CELL CLINIC LLC
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 1602 OAKFIELD DR STE 101
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City | BRANDON
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State | FL
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Zip | 33511-0827
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Country | US
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Telephone | 813-800-7836
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Fax | 813-200-2253
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Provider Business Mailing Address
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Address Line | 1602 OAKFIELD DR STE 101
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City | BRANDON
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State | FL
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Zip | 33511-0827
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Country | US
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Telephone | 813-800-7836
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Fax | 813-200-2253
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Authorized Official
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Title or Position | OWNER, FOUNDER
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Name | MRS. LEESA POLLEY
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Credential |
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Telephone | 850-591-1414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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