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General NPI Number Information
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NPI Number | 1255781639
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Entity Type | Organization
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Legal Business Name | BIOTRINETIX
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 12/13/2016
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Provider Practice Location Address
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Address Line | 1020 HOLLAND DR SUITE 115
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City | BOCA RATON
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State | FL
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Zip | 33487-5717
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Country | US
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Telephone | 207-299-5411
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Fax |
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Provider Business Mailing Address
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Address Line | 1020 HOLLAND DR SUITE 115
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City | BOCA RATON
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State | FL
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Zip | 33487-5717
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Country | US
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Telephone | 207-299-5411
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES M BLUM
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Credential |
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Telephone | 207-299-5411
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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 | ME18197
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 80028108
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License Number State | FL
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