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General NPI Number Information
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NPI Number | 1073244190
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Entity Type | Organization
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Legal Business Name | MEDICAL & CO. LLC
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Dates
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Enumeration Date | 06/20/2022
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Last Update Date | 06/20/2022
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Provider Practice Location Address
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Address Line | 417 NW 2ND AVE STE 1A
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-3302
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Country | US
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Telephone | 786-570-9234
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Fax |
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Provider Business Mailing Address
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Address Line | 250 95TH ST UNIT 545951
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City | SURFSIDE
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State | FL
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Zip | 33154-2820
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Country | US
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Telephone | 786-570-9234
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Fax |
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Authorized Official
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Title or Position | MGRM
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Name | SIMON EMMANUEL SHOSHAN
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Credential |
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Telephone | 786-570-9234
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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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