Healthcare Provider Details

I. General information

NPI: 1093072365
Provider Name (Legal Business Name): COMPLAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N TUTTLE AVE
SARASOTA FL
34237-6328
US

IV. Provider business mailing address

PO BOX 14802
BRADENTON FL
34280-4802
US

V. Phone/Fax

Practice location:
  • Phone: 941-243-3855
  • Fax: 941-243-3854
Mailing address:
  • Phone: 855-233-3755
  • Fax: 941-243-3854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: JEREMY WALDRIP
Title or Position: OWNER
Credential:
Phone: 941-284-8355