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General NPI Number Information
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NPI Number | 1467146324
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Entity Type | Organization
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Legal Business Name | TREASURE COAST DIAGNOSTIC LABORATORY INCORPORATED
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 142 NW SWANN MILL CIR
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986-3592
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Country | US
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Telephone | 772-773-0935
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 880245
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34988-0245
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Country | US
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Telephone | 772-773-0935
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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. RONDY LOUISSAINT
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Credential |
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Telephone | 772-773-0935
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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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