Healthcare Provider Details

I. General information

NPI: 1205746583
Provider Name (Legal Business Name): ADVANCED DIAGNOSTICS LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20129 NE 16TH PL
MIAMI FL
33179-2720
US

IV. Provider business mailing address

20129 NE 16TH PL
MIAMI FL
33179-2720
US

V. Phone/Fax

Practice location:
  • Phone: 702-786-5334
  • Fax:
Mailing address:
  • Phone: 702-786-5334
  • Fax:

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: RACHEL FAKHOURI
Title or Position: OWNER
Credential:
Phone: 702-786-5334