Healthcare Provider Details

I. General information

NPI: 1053424218
Provider Name (Legal Business Name): B & M OXIMETRY LAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 SW PLUM CT
PORT SAINT LUCIE FL
34953-5768
US

IV. Provider business mailing address

2351 SW PLUM CT
PORT SAINT LUCIE FL
34953-5768
US

V. Phone/Fax

Practice location:
  • Phone: 772-621-4299
  • Fax: 772-621-4195
Mailing address:
  • Phone: 772-621-4299
  • Fax: 772-621-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number729920041019
License Number StateFL

VIII. Authorized Official

Name: MRS. KATHIA S MONROIG
Title or Position: PRESIDENT
Credential:
Phone: 772-621-4299