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Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.

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Laboratory Management Specialist · PORT ORANGE, FL

Registration Details

NPI Number
1497611164
Provider Type
Individual
Gender
Male
NPI Issued
Dec 26, 2025 (0.32240517803539 yrs)
Last Updated
Dec 26, 2025
License
DI46878 (FL)

Practice Information

Address
735 DUNLAWTON AVE
PORT ORANGE, FL, 321279226
Browse FL providers · Browse ZIP 32127
Phone
8888080488
Fax
3868724232
Primary Specialty
Laboratory Management Specialist
246QL0900X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.