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General NPI Number Information
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NPI Number | 1477319143
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Entity Type | Organization
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Legal Business Name | LULU'S LICE REMOVAL CLINIC, LLC
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Dates
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Enumeration Date | 02/21/2024
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 5810 STATE ROAD 54
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-6050
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Country | US
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Telephone | 727-410-7013
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Fax |
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Provider Business Mailing Address
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Address Line | 5263 MILLER BAYOU DR
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City | PORT RICHEY
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State | FL
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Zip | 34668-6224
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Country | US
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Telephone | 727-410-7013
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | JOHN E FASSLER
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Credential | MD
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Telephone | 704-909-9414
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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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