Healthcare Provider Details

I. General information

NPI: 1215516760
Provider Name (Legal Business Name): HOME CLINIC LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 04/19/2021
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BRICKELL BAY DR APT 864
MIAMI FL
33131-2937
US

IV. Provider business mailing address

801 BRICKELL BAY DR APT 864
MIAMI FL
33131-2937
US

V. Phone/Fax

Practice location:
  • Phone: 305-389-8508
  • Fax:
Mailing address:
  • Phone: 305-389-8508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NAIKEL ANGEL RODRIGUEZ
Title or Position: AMBR
Credential:
Phone: 305-389-8508