Healthcare Provider Details

I. General information

NPI: 1083117535
Provider Name (Legal Business Name): QUALITY CLINICAL LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10816 US HIGHWAY 19
PORT RICHEY FL
34668-2564
US

IV. Provider business mailing address

10816 US HIGHWAY 19
PORT RICHEY FL
34668-2564
US

V. Phone/Fax

Practice location:
  • Phone: 813-334-9234
  • Fax: 813-334-9234
Mailing address:
  • Phone: 813-334-9234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name: KERIEN MARTIJA
Title or Position: OWNER
Credential:
Phone: 813-334-9234