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General NPI Number Information
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NPI Number | 1821471962
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Entity Type | Organization
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Legal Business Name | BREATH OF LIFE DIAGNOSTICS
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/07/2015
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Provider Practice Location Address
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Address Line | 3505 PROGRESS LN
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6519
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Country | US
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Telephone | 407-892-8925
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Fax | 407-892-8926
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Provider Business Mailing Address
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Address Line | 3505 PROGRESS LN
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6519
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Country | US
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Telephone | 407-892-8925
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Fax | 407-892-8926
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERTO GONZALEZ
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Credential | MD
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Telephone | 407-361-0755
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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 | 380652
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License Number State | FL
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