Healthcare Provider Details

I. General information

NPI: 1730820846
Provider Name (Legal Business Name): CDR LABORATORIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10305 NW 41ST ST STE 101
DORAL FL
33178-2975
US

IV. Provider business mailing address

11740 SW 80TH ST
MIAMI FL
33183-3848
US

V. Phone/Fax

Practice location:
  • Phone: 833-330-1647
  • Fax: 762-200-2460
Mailing address:
  • Phone: 833-330-1647
  • Fax: 762-200-2460

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: DOMINIC O WEILBAECHER
Title or Position: MANAGER, PAYER RELATIONS
Credential:
Phone: 504-250-2850