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General NPI Number Information
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NPI Number | 1659347037
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Entity Type | Organization
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Legal Business Name | VIERA DIAGNOSTIC CENTER LLC
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Dates
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Enumeration Date | 02/27/2006
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 7000 SPYGLASS CT SUITE 260
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City | VIERA
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State | FL
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Zip | 32940-8288
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Country | US
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Telephone | 321-254-7880
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Fax | 321-254-7707
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Provider Business Mailing Address
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Address Line | 7000 SPYGLASS CT SUITE 260
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City | VIERA
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State | FL
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Zip | 32940-8288
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Country | US
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Telephone | 321-254-7880
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Fax | 321-254-7707
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. FRANCIS ABAYOMI OLOMU
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Credential |
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Telephone | 321-254-7880
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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 | HCC5570
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License Number State | FL
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