Organization
GREEN LAKE VILLAGE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICARDO RODRIQUEZ FIGUEROA (OWNER)
(813) 280-1199
Entity
Organization
Contact information
Practice address
1107 E JACKSON ST STE 208, TAMPA, FL 33602-4161
(813) 280-1199
Mailing address
1107 E JACKSON ST STE 208, TAMPA, FL 33602-4161
(813) 280-1199
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
10/08/2024
Last updated
10/08/2024
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