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General NPI Number Information
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NPI Number | 1821081100
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Entity Type | Organization
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Legal Business Name | CYBERMED DIAGNOSTIC LAB
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9380 SW 72ND ST
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City | MIAMI
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State | FL
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Zip | 33173-3276
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Country | US
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Telephone | 305-598-1864
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Fax | 305-598-1874
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Provider Business Mailing Address
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Address Line | 9380 SW 72ND ST
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City | MIAMI
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State | FL
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Zip | 33173-3244
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Country | US
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Telephone | 305-598-1864
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Fax | 305-598-1874
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Authorized Official
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Title or Position | PRESIDENT CEO
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Name | MR. HUMBERTO BORQUE
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Credential |
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Telephone | 305-300-1641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | HCC6120
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License Number State | FL
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