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General NPI Number Information
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NPI Number | 1548974157
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Entity Type | Organization
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Legal Business Name | ICON LABS INC.
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Dates
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Enumeration Date | 01/09/2023
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Last Update Date | 01/09/2023
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Provider Practice Location Address
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Address Line | 4891 NW 103RD AVE STE 11J
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City | SUNRISE
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State | FL
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Zip | 33351-7955
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Country | US
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Telephone | 954-854-8971
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Fax |
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Provider Business Mailing Address
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Address Line | 5944 CORAL RIDGE DR # 246
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City | CORAL SPRINGS
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State | FL
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Zip | 33076-3300
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Country | US
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Telephone | 954-854-8971
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIVINA BRINKLEY
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Credential |
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Telephone | 954-854-8971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247ZC0005X
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Taxonomy Name | Clinical Laboratory Director (Non-physician)
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License Number |
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License Number State |
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