Healthcare Provider Details

I. General information

NPI: 1467294769
Provider Name (Legal Business Name): PRECISION DIAGNOSTICS LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9690 W SAMPLE RD STE 202
CORAL SPRINGS FL
33065-4053
US

IV. Provider business mailing address

9690 W SAMPLE RD STE 202
CORAL SPRINGS FL
33065-4053
US

V. Phone/Fax

Practice location:
  • Phone: 786-236-3402
  • Fax: 786-923-0980
Mailing address:
  • Phone: 786-623-6886
  • Fax: 786-923-0980

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: MICHELLE ROCHA
Title or Position: MANAGING MEMBER
Credential:
Phone: 786-623-6886