Healthcare Provider Details

I. General information

NPI: 1699369405
Provider Name (Legal Business Name): PINK MOBILE LABS & DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 NE 214TH ST UNIT 8TH
AVENTURA FL
33180-1268
US

IV. Provider business mailing address

2820 NE 214TH ST UNIT 8TH
AVENTURA FL
33180-1268
US

V. Phone/Fax

Practice location:
  • Phone: 754-300-9290
  • Fax: 754-220-9053
Mailing address:
  • Phone: 754-300-9290
  • Fax: 754-220-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SARAH MONIQUE DENNIS
Title or Position: OWNER
Credential:
Phone: 754-300-9290