Provider Demographics
NPI:1285806083
Name:SONICARE DIAGNOSTICS, LLC
Entity type:Organization
Organization Name:SONICARE DIAGNOSTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LARA
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BLYSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT, RDCS
Authorized Official - Phone:407-221-5665
Mailing Address - Street 1:2570 GROVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-9646
Mailing Address - Country:US
Mailing Address - Phone:407-221-5665
Mailing Address - Fax:407-386-7077
Practice Address - Street 1:2570 GROVELAND AVE
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-9646
Practice Address - Country:US
Practice Address - Phone:407-221-5665
Practice Address - Fax:407-386-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARDMS 99517246XS1301X, 2471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Single Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty