Provider Demographics
NPI:1265624480
Name:AVIGOS MANAGEMENT, LLC
Entity type:Organization
Organization Name:AVIGOS MANAGEMENT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:ESTUARDO
Authorized Official - Last Name:MIJANGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-365-3070
Mailing Address - Street 1:110 BURNSED PL
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7650
Mailing Address - Country:US
Mailing Address - Phone:407-365-3070
Mailing Address - Fax:407-386-7399
Practice Address - Street 1:110 BURNSED PL
Practice Address - Street 2:SUITE 1020
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-7650
Practice Address - Country:US
Practice Address - Phone:407-365-3070
Practice Address - Fax:407-386-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL07000036187293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory