Healthcare Provider Details

I. General information

NPI: 1598418758
Provider Name (Legal Business Name): INNOVATIVE LABS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
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: 954-702-5224
  • Fax:
Mailing address:
  • Phone: 954-702-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. JASMINE C NOEL
Title or Position: PRESIDENT
Credential:
Phone: 954-621-8674