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General NPI Number Information
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NPI Number | 1801547104
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Entity Type | Organization
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Legal Business Name | TJ EXPRESS LAB, LLC
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/18/2022
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Provider Practice Location Address
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Address Line | 1103 NE 33RD ST
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City | POMPANO BEACH
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State | FL
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Zip | 33064-5226
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Country | US
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Telephone | 954-892-4554
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 971130
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City | COCONUT CREEK
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State | FL
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Zip | 33097-1130
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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 | MANAGING PARTNER
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Name | MS. TACIANA F ALCOFORADO
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Credential | NCPT
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Telephone | 978-727-5654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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