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General NPI Number Information
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NPI Number | 1770103699
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Entity Type | Organization
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Legal Business Name | MOBIL LAB FOR ALL INC
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 1053 SW 12TH ST
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City | BOCA RATON
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State | FL
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Zip | 33486-5490
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Country | US
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Telephone | 561-386-7182
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Fax |
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Provider Business Mailing Address
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Address Line | 1053 SW12TH ST
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City | BOCA RATON
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State | FL
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Zip | 33486
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Country | US
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Telephone | 561-386-7182
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. ROSA I RIVERA
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Credential | ASCP
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Telephone | 561-386-7182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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