Healthcare Provider Details

I. General information

NPI: 1982476040
Provider Name (Legal Business Name): TLC CONCIERGE MOBILE LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 PLAZA REAL STE 275
BOCA RATON FL
33432-3999
US

IV. Provider business mailing address

141 NE 15TH TER
BOCA RATON FL
33432-1825
US

V. Phone/Fax

Practice location:
  • Phone: 213-315-3909
  • Fax:
Mailing address:
  • Phone: 213-315-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: MS. VANESSA MOSS
Title or Position: DIRECTOR
Credential:
Phone: 213-315-3909