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General NPI Number Information
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NPI Number | 1205571122
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Entity Type | Organization
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Legal Business Name | KDS MOBILE LAB TESTING LLC
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 5521 SW 99TH AVE
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City | COOPER CITY
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State | FL
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Zip | 33328-5705
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Country | US
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Telephone | 863-313-0378
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Fax | 866-926-1067
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Provider Business Mailing Address
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Address Line | 5521 SW 99TH AVE
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City | COOPER CITY
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State | FL
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Zip | 33328-5705
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Country | US
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Telephone | 863-313-0378
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Fax | 866-926-1067
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAISHIA DOLLAR
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Credential |
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Telephone | 786-624-9693
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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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