Provider Demographics
NPI:1427569920
Name:UNDERSEA OXYGEN CLINIC LLC
Entity Type:Organization
Organization Name:UNDERSEA OXYGEN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DITURI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD(C)
Authorized Official - Phone:813-533-7095
Mailing Address - Street 1:701 N WEST SHORE BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1122
Mailing Address - Country:US
Mailing Address - Phone:813-533-7093
Mailing Address - Fax:
Practice Address - Street 1:701 N WEST SHORE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1122
Practice Address - Country:US
Practice Address - Phone:813-533-7093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIBUM-2343-0010261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center