Provider Demographics
NPI:1689082968
Name:TRIDENT DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:TRIDENT DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:MANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:TANEJA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-544-4019
Mailing Address - Street 1:4919 W MELROSE AVE S
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5419
Mailing Address - Country:US
Mailing Address - Phone:727-544-4019
Mailing Address - Fax:
Practice Address - Street 1:4919 W MELROSE AVE S
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5419
Practice Address - Country:US
Practice Address - Phone:727-544-4019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty