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General NPI Number Information
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NPI Number | 1902492671
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Entity Type | Organization
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Legal Business Name | ANOTHER CHANCE DIAGNOSTIC LABORATORY LLC
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 3901 TITELIST CT APT 2337
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City | ORLANDO
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State | FL
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Zip | 32839-3296
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Country | US
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Telephone | 407-403-2061
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Fax |
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Provider Business Mailing Address
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Address Line | 3901 TITELIST CT APT 2337
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City | ORLANDO
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State | FL
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Zip | 32839-3296
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Country | US
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Telephone | 407-403-2061
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | LA TOYA DAWSON
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Credential |
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Telephone | 352-231-7551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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