Healthcare Provider Details

I. General information

NPI: 1356454755
Provider Name (Legal Business Name): CMLAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20861 JOHNSON STREET SUITE 117-118
PEMBROKE PINES FL
33029
US

IV. Provider business mailing address

20861 JOHNSON ST SUITE 117-118
PEMBROKE PINES FL
33029-1926
US

V. Phone/Fax

Practice location:
  • Phone: 954-704-9116
  • Fax: 954-704-8823
Mailing address:
  • Phone: 954-704-9116
  • Fax: 954-704-8823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number800020862
License Number StateFL

VIII. Authorized Official

Name: MRS. MARTHA C OROZCO
Title or Position: MEDICAL TECHNOLOGIST SUPERVISOR VP
Credential: MT
Phone: 954-704-9116