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General NPI Number Information
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NPI Number | 1447873344
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Entity Type | Organization
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Legal Business Name | RICO LAB SERVICES
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Dates
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Enumeration Date | 05/26/2020
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Last Update Date | 06/14/2020
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Provider Practice Location Address
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Address Line | 601 S HARBOUR ISLAND BLVD STE 109
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City | TAMPA
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State | FL
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Zip | 33602-5927
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Country | US
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Telephone | 813-419-2934
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Fax |
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Provider Business Mailing Address
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Address Line | 601 S HARBOUR ISLAND BLVD STE 109
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City | TAMPA
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State | FL
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Zip | 33602-5927
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Country | US
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Telephone | 813-419-2934
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. FEDERICO GORDON JR.
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Credential | MBA, MLS(ASCP)
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Telephone | 813-419-2934
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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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