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General NPI Number Information
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NPI Number | 1851573398
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Entity Type | Organization
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Legal Business Name | FVT LAB CORP
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 15668 SW 72ND ST
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City | MIAMI
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State | FL
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Zip | 33193-1923
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Country | US
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Telephone | 305-386-0323
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Fax | 305-386-0242
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Provider Business Mailing Address
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Address Line | 15668 SW 72ND ST
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City | MIAMI
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State | FL
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Zip | 33193-1923
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Country | US
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Telephone | 305-386-0323
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Fax | 305-386-0242
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Authorized Official
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Title or Position | OWNER
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Name | MR. FABIANO SILVA
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Credential |
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Telephone | 305-386-0323
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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 | 601073-0
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License Number State | FL
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