Healthcare Provider Details

I. General information

NPI: 1770103699
Provider Name (Legal Business Name): MOBIL LAB FOR ALL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 SW 12TH ST
BOCA RATON FL
33486-5490
US

IV. Provider business mailing address

1053 SW12TH ST
BOCA RATON FL
33486
US

V. Phone/Fax

Practice location:
  • Phone: 561-386-7182
  • Fax:
Mailing address:
  • Phone: 561-386-7182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSA I RIVERA
Title or Position: PROPRIETOR
Credential: ASCP
Phone: 561-386-7182