DEAISA BOMORT

Driver

Active Individual
NPI: 1558035717

Practice Address

1836 N CRYSTAL LAKE DR
Lakeland, FL 33801

Phone: (863) 738-9493

Specialties

Specialty Code Primary License
Driver 172A00000X Yes B563179949530 (FL)

Frequently Asked Questions

NPI 1558035717 is the National Provider Identifier for DEAISA BOMORT, a Driver provider located in Lakeland, FL. This NPI was enumerated on August 2, 2021.
DEAISA BOMORT practices at 1836 N CRYSTAL LAKE DR, Lakeland, FL 33801.

Quick Facts

NPI
1558035717
Type
Individual
Enumerated
Aug 2, 2021
Last Updated
Aug 2, 2021

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