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Organization

WELLNESS DIAGNOSTICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID SMITH (CFO)
(904) 791-6471
Entity
Organization

Contact information

Practice address
854 EMERALD BAY RD STE C, SOUTH LAKE TAHOE, CA 96150-6438
(530) 544-2020
Mailing address
854 EMERALD BAY RD STE C, SOUTH LAKE TAHOE, CA 96150-6438
(530) 544-2020

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
K11111
CA

Other

Enumeration date
01/17/2012
Last updated
01/17/2012
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