Provider Demographics
NPI:1841787157
Name:RD HEALTH DIAGNOSTIC LLC
Entity Type:Organization
Organization Name:RD HEALTH DIAGNOSTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HILLARI
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-356-1454
Mailing Address - Street 1:1977 ALAFAYA TRL STE 1121
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4522
Mailing Address - Country:US
Mailing Address - Phone:321-356-1454
Mailing Address - Fax:321-283-6175
Practice Address - Street 1:1977 ALAFAYA TRL STE 1121
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4522
Practice Address - Country:US
Practice Address - Phone:321-356-1454
Practice Address - Fax:321-283-6175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D2137170291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2137170OtherCLIA ID