Lake Center of H.o.p.e., PA

NPI #1366647802 in Leesburg, Florida

Provider Information

NPI Number: 1366647802
Entity Type: Organization
Organization Name: Lake Center of H.o.p.e., PA
Primary Specialty: Specialist
Enumeration Date: Jun 15, 2007
Last Updated: Oct 21, 2013

Practice Location

Address: 33057 PROFESSIONAL DRIVE
Address 2: SUITE 102
City: Leesburg
State: Florida
ZIP Code: 34788
Phone: (352) 787-0081

Authorized Official

Name: MRS. LOURDES NICOLAS UNGSON, OFFICE MANAGER
Title: SECRETARY TREASURER
Phone: (352) 787-0081

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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