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General NPI Number Information
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NPI Number | 1871924977
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Entity Type | Organization
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Legal Business Name | SEA LABORATORIES, LLC
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Dates
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Enumeration Date | 11/29/2013
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Last Update Date | 11/29/2013
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Provider Practice Location Address
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Address Line | 519 E BLOOMINGDALE AVE SUITE A
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City | BRANDON
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State | FL
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Zip | 33511-8180
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Country | US
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Telephone | 352-789-2031
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 SW 49TH RD
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City | OCALA
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State | FL
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Zip | 34474-6262
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Country | US
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Telephone | 352-789-2031
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KAMACHIE CHINAPIN
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Credential |
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Telephone | 352-789-2031
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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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