=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659805224
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARJUN LABS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2017
-----------------------------------------------------
Last Update Date | 04/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6600 SW HIGHWAY 200 200
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-502-2557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1920 SW 28TH STREET
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-502-2557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LAB MANAGER
-----------------------------------------------------
Name | JERONDIO ENCIENZO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-502-2557
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------