Provider Demographics
NPI:1992260566
Name:PRECIOUS MOMENTS 3D - 4D LLC
Entity type:Organization
Organization Name:PRECIOUS MOMENTS 3D - 4D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:863-529-7448
Mailing Address - Street 1:5336 US HIGHWAY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-0517
Mailing Address - Country:US
Mailing Address - Phone:863-816-3870
Mailing Address - Fax:863-434-7586
Practice Address - Street 1:5336 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-0517
Practice Address - Country:US
Practice Address - Phone:863-816-3870
Practice Address - Fax:863-434-7586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-07
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty