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General NPI Number Information
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NPI Number | 1780407502
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Entity Type | Organization
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Legal Business Name | VENTRA LABS, LLC
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 106 N EVERS ST
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City | PLANT CITY
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State | FL
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Zip | 33563
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Country | US
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Telephone | 813-704-5616
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Fax | 813-441-7672
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Provider Business Mailing Address
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Address Line | 106 N EVERS ST
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City | PLANT CITY
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State | FL
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Zip | 33563
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Country | US
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Telephone | 813-704-5616
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Fax | 813-441-7672
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MATTHEW CHANDLER
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Credential |
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Telephone | 813-763-5607
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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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