Healthcare Provider Details

I. General information

NPI: 1770340754
Provider Name (Legal Business Name): OBAS LAB DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 NE 214TH ST STE 809
AVENTURA FL
33180-1270
US

IV. Provider business mailing address

2820 NE 214TH ST STE 809
AVENTURA FL
33180-1270
US

V. Phone/Fax

Practice location:
  • Phone: 754-600-1396
  • Fax: 754-778-6023
Mailing address:
  • Phone: 754-600-1396
  • Fax: 754-778-6023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROSE-ESTELLE TANIA CELESTIN-OBAS
Title or Position: DIRECTOR OF OPERATIONS
Credential: ARNP
Phone: 786-395-5481