Organization
ULTRACARE MOBILE DIAGNOSTIC IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DEBORAH Y. HAZELBAKER RDMS (SOLE PROPRIETOR)
(321) 795-7396
Entity
Organization
Contact information
Practice address
4181 IONA ST, TITUSVILLE, FL 32796-2222
(321) 795-7396
(321) 225-4936
Mailing address
4181 IONA ST, TITUSVILLE, FL 32796-2222
(321) 795-7396
(321) 225-4936
Taxonomy
Speciality
Code
Description
License number
State
2471S1302X
Sonography Radiologic Technologist
Primary
57090
FL
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
57090
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
885043603
BUSINESS LICENSE #
FL
Enumeration date
09/15/2009
Last updated
11/18/2009
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