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General NPI Number Information
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NPI Number | 1396157608
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Entity Type | Organization
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Legal Business Name | LABSURE LLC
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 150 E SAMPLE RD STE 120
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3550
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Country | US
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Telephone | 954-320-4360
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Fax |
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Provider Business Mailing Address
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Address Line | 150 E SAMPLE RD STE 120
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City | POMPANO BEACH
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State | FL
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Zip | 33064-3550
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RAYMOND J DIIULIO
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Credential |
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Telephone | 954-320-4360
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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 | 10D2066186
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License Number State | FL
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