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General NPI Number Information
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NPI Number | 1023677499
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Entity Type | Organization
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Legal Business Name | GENETICS INSTITUTE OF AMERICA LABORATORY FL1 CORP
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Dates
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Enumeration Date | 06/10/2019
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 4733 W ATLANTIC AVE STE C16
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City | DELRAY BEACH
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State | FL
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Zip | 33445-3706
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Country | US
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Telephone | 561-455-2162
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Fax | 561-354-5369
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Provider Business Mailing Address
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Address Line | 4733 W ATLANTIC AVE STE 12C
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City | DELRAY BEACH
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State | FL
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Zip | 33445-3890
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Country | US
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Telephone | 561-475-3069
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | HOLLY MAGLIOCHETTI
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Credential |
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Telephone | 561-445-2162
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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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