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General NPI Number Information
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NPI Number | 1942721493
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Entity Type | Organization
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Legal Business Name | NEW VISTA DIAGNOSTIC IMAGING SERVICES LLC
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2802 W WATERS AVE STE 1
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City | TAMPA
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State | FL
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Zip | 33614-1853
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Country | US
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Telephone | 813-724-3310
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Fax | 813-280-4923
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Provider Business Mailing Address
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Address Line | 2802 W WATERS AVE STE 1
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City | TAMPA
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State | FL
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Zip | 33614-1853
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Country | US
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Telephone | 813-724-3310
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Fax | 813-280-4923
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LESSY RODRIGUEZ
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Credential |
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Telephone | 813-724-3310
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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 |
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License Number State |
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