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General NPI Number Information
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NPI Number | 1184597098
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Entity Type | Organization
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Legal Business Name | PRODRAW MOBILE LABS, LLC
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Dates
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Enumeration Date | 09/26/2025
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Last Update Date | 09/26/2025
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Provider Practice Location Address
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Address Line | 17348 MONTE ISOLA WAY NORTH
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City | FORT MYERS
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State | FL
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Zip | 33917
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Country | US
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Telephone | 239-328-3236
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Fax |
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Provider Business Mailing Address
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Address Line | 17348 MONTE ISOLA WAY
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City | NORTH FORT MYERS
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State | FL
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Zip | 33917-2177
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Country | US
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Telephone | 239-328-3236
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Fax |
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Authorized Official
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Title or Position | OWNER/PLEBOTOMIST
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Name | LORENA BENCOSME
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Credential | CMA, CPT, CET
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Telephone | 239-328-3236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291900000X
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Taxonomy Name | Military Clinical Medical Laboratory
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License Number |
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License Number State |
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