Individual
LAGENA DIAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
908 DELANEY CIR APT 208, BRANDON, FL 33511-1914
(813) 787-8642
Mailing address
PO BOX 1713, BRANDON, FL 33509-1713
(813) 787-8642
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
05/16/2022
Last updated
05/16/2022
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