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General NPI Number Information
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NPI Number | 1013558709
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Entity Type | Organization
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Legal Business Name | CONVENIENT LABORATORIES LLC
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 183 STERLING SPRINGS LN
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3856
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Country | US
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Telephone | 407-775-9705
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Fax |
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Provider Business Mailing Address
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Address Line | 183 STERLING SPRINGS LN
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-3856
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Country | US
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Telephone | 407-775-9705
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Fax | 941-251-8467
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Authorized Official
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Title or Position | OWNER
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Name | NICODEMME JEAN-BAPTISTE
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Credential |
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Telephone | 941-527-9169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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