Provider Demographics
NPI:1134312796
Name:MOBILE IN-BALANCE DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:MOBILE IN-BALANCE DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONIDES
Authorized Official - Middle Name:G
Authorized Official - Last Name:FINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-451-5897
Mailing Address - Street 1:4305 VINELAND RD
Mailing Address - Street 2:STE G15
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-7177
Mailing Address - Country:US
Mailing Address - Phone:407-451-5897
Mailing Address - Fax:407-386-6267
Practice Address - Street 1:4305 VINELAND RD
Practice Address - Street 2:STE G15
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-7177
Practice Address - Country:US
Practice Address - Phone:407-451-5897
Practice Address - Fax:407-386-6267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory