Provider Demographics
NPI:1992458624
Name:PREFERRED PERFORMANCE LLC
Entity type:Organization
Organization Name:PREFERRED PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COSMETOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:COSMETOLOGIST
Authorized Official - Phone:727-481-1152
Mailing Address - Street 1:3135 1ST AVE N # 12735
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33730-9990
Mailing Address - Country:US
Mailing Address - Phone:727-481-1152
Mailing Address - Fax:727-481-1152
Practice Address - Street 1:5002 22ND AVE S
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:FL
Practice Address - Zip Code:33707-4942
Practice Address - Country:US
Practice Address - Phone:727-481-1152
Practice Address - Fax:727-481-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier