Healthcare Provider Details

I. General information

NPI: 1023763992
Provider Name (Legal Business Name): EMBRY TESTING AND VACCINE SERVICES OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 S STAPLEY DR STE 241
MESA AZ
85204-6667
US

IV. Provider business mailing address

PO BOX 63153
PHOENIX AZ
85082-3153
US

V. Phone/Fax

Practice location:
  • Phone: 480-376-2175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND EMBRY
Title or Position: CEO
Credential:
Phone: 480-376-2170