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General NPI Number Information
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NPI Number | 1245469527
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Entity Type | Organization
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Legal Business Name | CENTURY CLINICAL LAB, INC.
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 1395 SHOTGUN RD
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City | SUNRISE
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State | FL
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Zip | 33326
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Country | US
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Telephone | 954-678-1263
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Fax | 754-223-2249
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Provider Business Mailing Address
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Address Line | 1395 SHOTGUN RD
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City | SUNRISE
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State | FL
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Zip | 33326
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Country | US
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Telephone | 954-678-1263
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Fax | 754-223-2249
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Authorized Official
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Title or Position | CEO
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Name | MR. RUBEN VALDES SR.
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Credential |
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Telephone | 954-594-4091
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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 | FL
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