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General NPI Number Information
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NPI Number | 1700594223
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Entity Type | Organization
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Legal Business Name | CARLOS A LABRADOR MDPA
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 11/14/2022
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Provider Practice Location Address
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Address Line | 2200 56TH ST S
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City | GULFPORT
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State | FL
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Zip | 33707-5004
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Country | US
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Telephone | 952-653-2525
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 56TH ST S
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City | GULFPORT
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State | FL
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Zip | 33707-5004
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Country | US
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Telephone | 952-653-2525
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Fax |
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Authorized Official
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Title or Position | MDPA
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Name | CARLOS A LABRADOR
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Credential |
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Telephone | 727-381-8006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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