Healthcare Provider Details

I. General information

NPI: 1447713128
Provider Name (Legal Business Name): SPECTRUM DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 SE OSCEOLA ST STE 5
STUART FL
34994-2431
US

IV. Provider business mailing address

5283 W ATLANTIC AVE
DELRAY BEACH FL
33484-8134
US

V. Phone/Fax

Practice location:
  • Phone: 877-779-3711
  • Fax: 888-726-8451
Mailing address:
  • Phone: 877-779-3711
  • Fax: 888-726-8451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ALVIS VINCENT PUGLIESE
Title or Position: OWNER
Credential:
Phone: 877-779-3711