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General NPI Number Information
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NPI Number | 1760602510
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Entity Type | Organization
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Legal Business Name | TRI COUNTY PET LLC
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 603 N FLAMINGO RD 155
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1023
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Country | US
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Telephone | 954-450-2202
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Fax | 954-450-8401
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Provider Business Mailing Address
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Address Line | 603 N FLAMINGO RD 155
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1023
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Country | US
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Telephone | 954-450-2202
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Fax | 954-450-8401
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | LISETTE CRUZ-DENO
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Credential |
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Telephone | 954-450-2202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | HCC5508
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License Number State | FL
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