Healthcare Provider Details

I. General information

NPI: 1114976784
Provider Name (Legal Business Name): MARBE LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 SW 116TH PL
MIAMI FL
33173-4796
US

IV. Provider business mailing address

6303 SW 116TH PL
MIAMI FL
33173-4770
US

V. Phone/Fax

Practice location:
  • Phone: 305-989-3793
  • Fax: 305-271-8074
Mailing address:
  • Phone: 305-989-3793
  • Fax: 305-271-8074

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: AURA L IVANOFF
Title or Position: PRESIDENT
Credential:
Phone: 305-989-3793