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General NPI Number Information
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NPI Number | 1801214598
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Entity Type | Organization
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Legal Business Name | ULTIMATE ANALYSIS LABS, LLC
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 2437 S 17TH PL
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City | PHOENIX
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State | AZ
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Zip | 85034-6706
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Country | US
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Telephone | 561-866-0012
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Fax |
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Provider Business Mailing Address
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Address Line | 701 S SWINTON AVE
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City | DELRAY BEACH
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State | FL
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Zip | 33444-2377
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO, PRES
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Name | FRANK CID
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Credential |
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Telephone | 561-866-0012
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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 | AZ
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