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General NPI Number Information
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NPI Number | 1518325943
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Entity Type | Organization
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Legal Business Name | CQB SERVICES LLC
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Dates
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Enumeration Date | 01/30/2016
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Last Update Date | 01/30/2016
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Provider Practice Location Address
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Address Line | 4344 PLACID PL
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City | CLERMONT
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State | FL
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Zip | 34714-6523
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Country | US
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Telephone | 352-348-8464
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Fax |
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Provider Business Mailing Address
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Address Line | 4344 PLACID PL
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City | CLERMONT
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State | FL
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Zip | 34714-6523
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Country | US
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Telephone | 352-348-8464
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JULIEN TRAN
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Credential | PHARMD
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Telephone | 352-348-8464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | PS46838
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License Number State | FL
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