Healthcare Provider Details

I. General information

NPI: 1326482316
Provider Name (Legal Business Name): JOSANA MEDICAL LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 04/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

478 W HILLSBORO BLVD
DEERFIELD BEACH FL
33441-1604
US

IV. Provider business mailing address

478 W HILLSBORO BLVD
DEERFIELD BEACH FL
33441-1604
US

V. Phone/Fax

Practice location:
  • Phone: 954-949-9917
  • Fax:
Mailing address:
  • Phone: 954-949-9917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberME83309
License Number StateFL

VIII. Authorized Official

Name: DR. DANIEL MORRIS JACOBS
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: M.D.
Phone: 954-895-2862