Healthcare Provider Details

I. General information

NPI: 1396568168
Provider Name (Legal Business Name): INNOVATIVE LABS OF SFL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 NE 2ND TER
POMPANO BEACH FL
33060-5222
US

IV. Provider business mailing address

1710 NE 2ND TER
POMPANO BEACH FL
33060-5222
US

V. Phone/Fax

Practice location:
  • Phone: 954-859-4030
  • Fax:
Mailing address:
  • Phone: 954-859-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. JASMINE NOEL
Title or Position: PRESIDENT
Credential:
Phone: 954-859-4030