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204 Lake Harris Dr Lakeland FL 33813-2632 | |
| (863) 646-7733 | |
| (863) 646-7733 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 204 Lake Harris Dr, Lakeland, Florida |
| Authorized Official Name and Position | Evaristo Placedes Badiola (MANAGING MEMBER) |
| Authorized Official Contact | 8636467733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
204 Lake Harris Dr Lakeland FL 33813-2632 Ph: (863) 646-7733 | 204 Lake Harris Dr Lakeland FL 33813-2632 Ph: (863) 646-7733 |
| NPI Number | 1285689372 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285689372 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | ME0047939 (Florida) | Primary |
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