=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447843750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRO DIAMETRICS CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2021
-----------------------------------------------------
Last Update Date | 02/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9627 S DIXIE HWY
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-532-0005
-----------------------------------------------------
Fax | 305-406-9403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9627 S DIXIE HWY
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-532-0005
-----------------------------------------------------
Fax | 305-406-9403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED PERSON
-----------------------------------------------------
Name | ANNA A MKHITARIAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-697-1828
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------