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General NPI Number Information
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NPI Number | 1134901598
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Entity Type | Organization
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Legal Business Name | STADIA LABS INC
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Dates
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Enumeration Date | 10/19/2023
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Last Update Date | 01/06/2024
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Provider Practice Location Address
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Address Line | 1200 NW 78TH AVE STE 111
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City | DORAL
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State | FL
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Zip | 33126-1816
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Country | US
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Telephone | 786-773-5421
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 NW 78TH AVE STE 111
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City | DORAL
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State | FL
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Zip | 33126-1816
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Country | US
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Telephone | 786-773-5421
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CHEVERAL DEACON
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Credential |
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Telephone | 305-491-3809
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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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