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General NPI Number Information
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NPI Number | 1932568953
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Entity Type | Organization
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Legal Business Name | CORE BIOTECH SYSTEMS LLC
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Dates
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Enumeration Date | 02/18/2016
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 1325 S KILLIAN DR UNIT 1
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City | LAKE PARK
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State | FL
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Zip | 33403-1965
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Country | US
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Telephone | 561-929-9928
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 S KILLIAN DR UNIT 1
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City | LAKE PARK
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State | FL
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Zip | 33403-1965
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Country | US
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Telephone | 561-929-9928
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. JESSE PETERS
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Credential |
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Telephone | 561-929-9928
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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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