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General NPI Number Information
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NPI Number | 1437302932
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Entity Type | Organization
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Legal Business Name | HEALTHY 4 LIFE IMAGING, LLC
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 6856 S ROUND LAKE RD
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City | MOUNT DORA
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State | FL
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Zip | 32757-9645
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Country | US
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Telephone | 407-880-3313
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Fax | 407-880-3313
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Provider Business Mailing Address
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Address Line | 6856 S ROUND LAKE RD
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City | MOUNT DORA
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State | FL
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Zip | 32757-9645
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Country | US
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Telephone | 407-880-3313
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Fax | 407-880-3313
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Authorized Official
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Title or Position | DIRECT OWNER
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Name | MRS. DEBRA MAE ADAMS-WELCH
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Credential | RDMS, ARRT
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Telephone | 407-880-3313
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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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