Organization
VISTA CLINICAL DIAGNOSTICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVIAN S SANTANA (PRESIDENT)
(352) 536-9270
Entity
Organization
Contact information
Practice address
4290 S HWY 27, SUITE 201, CLERMONT, FL 34711-8066
(352) 536-9270
(352) 536-9279
Mailing address
4290 S HWY 27, SUITE 201, CLERMONT, FL 34711-8066
(352) 536-9270
(352) 536-9279
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800027066
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800018794
STATE LICENSE NUMBER
FL
Enumeration date
12/13/2005
Last updated
06/13/2014
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