Basic Information
| Provider Information | |||||||||
| NPI: | 1093939290 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKELAND VOLUNTEERS IN MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 LAKELAND HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636885846 | ||||||||
| FaxNumber: | 8638024640 | ||||||||
| Practice Location | |||||||||
| Address1: | 1021 LAKELAND HILLS BLVD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338054672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636885846 | ||||||||
| FaxNumber: | 8638024640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2007 | ||||||||
| LastUpdateDate: | 05/16/2011 | ||||||||
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| AuthorizedOfficialLastName: | BARRIOS | ||||||||
| AuthorizedOfficialFirstName: | JUAN | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8636885846 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251V00000X | Y | Agencies | Voluntary or Charitable |
No ID Information.