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General NPI Number Information
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NPI Number | 1922007947
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Entity Type | Organization
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Legal Business Name | UNILAB OF DADE INC
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Dates
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Enumeration Date | 07/20/2005
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Last Update Date | 07/20/2010
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Provider Practice Location Address
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Address Line | 2145 DAVIE BLVD #106
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-3161
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Country | US
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Telephone | 954-792-7422
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Fax | 954-797-9494
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Provider Business Mailing Address
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Address Line | 2145 DAVIE BLVD #106
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-3161
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Country | US
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Telephone | 954-792-7422
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Fax | 954-797-9494
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Authorized Official
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Title or Position | V.P
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Name | MR. JULIO E CORTES JR.
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Credential | BS
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Telephone | 954-792-7422
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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 | 10D0284855
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License Number State | FL
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