Healthcare Provider Details

I. General information

NPI: 1427522580
Provider Name (Legal Business Name): JBS DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2019
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HIGH RIDGE RD STE 600
BOYNTON BEACH FL
33426-8731
US

IV. Provider business mailing address

9098 PARAGON WAY
BOYNTON BEACH FL
33472-5112
US

V. Phone/Fax

Practice location:
  • Phone: 561-502-6289
  • Fax: 561-491-5519
Mailing address:
  • Phone: 561-502-6289
  • Fax: 561-491-5519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. JEAN SAMUEL SANON
Title or Position: /SECRETARYTREASURER
Credential:
Phone: 561-502-6289