Provider Demographics
NPI:1427393255
Name:LITTLE LIFE IMAGING
Entity Type:Organization
Organization Name:LITTLE LIFE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:LABERGE
Authorized Official - Suffix:
Authorized Official - Credentials:SONOGRAPHER
Authorized Official - Phone:407-892-1059
Mailing Address - Street 1:213 S DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3596
Mailing Address - Country:US
Mailing Address - Phone:407-892-1059
Mailing Address - Fax:
Practice Address - Street 1:213 S DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3596
Practice Address - Country:US
Practice Address - Phone:407-892-1059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty