Provider Demographics
NPI:1043965320
Name:TOLA DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:TOLA DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:QUATRILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS-HALL
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:407-687-9938
Mailing Address - Street 1:1376 POLK AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-6933
Mailing Address - Country:US
Mailing Address - Phone:407-687-9938
Mailing Address - Fax:
Practice Address - Street 1:1376 POLK AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32738-6933
Practice Address - Country:US
Practice Address - Phone:407-687-9938
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory