Most Relevant Information
Provider Data
| NPI Number: | 1003371618 |
| Provider Name: | HAE S LARENS |
| Entity Type: | Individual |
| Taxonomy Code: | 335E00000X |
| Specialty: | Prosthetic/Orthotic Supplier |
| License Number: | 74-8012445996-9 |
Most Important Dates
| Enumeration Date: | 02/07/2019 |
| Last Updated: | 02/07/2019 |
Provider Practice Location
120 S BEACH ST
DAYTONA BEACH
FL
321144402
Practice Location Phone/Fax
| Phone: | 3862588920 |
| Fax: |
Provider Mailing Location
120 S BEACH ST
DAYTONA BEACH
FL
321144402
Provider Mailing Phone/Fax
| Phone: | 3862588920 |
| Fax: |