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3105 W Waters Ave Ste 105 Tampa FL 33614-2846 | |
| (813) 443-0705 | |
| (813) 415-2982 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 3105 W Waters Ave Ste 105, Tampa, Florida |
| Authorized Official Name and Position | Yonaika Lara (OWNER) |
| Authorized Official Contact | 8134152982 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3105 W Waters Ave Ste 105 Tampa FL 33614-2846 Ph: () - | 3105 W Waters Ave Ste 105 Tampa FL 33614-2846 Ph: (813) 443-0705 |
| NPI Number | 1104457977 |
|---|---|
| Provider Enumeration Date | 01/30/2020 |
| Last Update Date | 02/07/2020 |
| Certification Date | 02/07/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104457977 | NPI | - | NPPES |
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