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NPI Code Detail

MEDICARE: FLORIDA DEPARTMENT OF HEALTH

MEDICARE: FLORIDA DEPARTMENT OF HEALTH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory800001191FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083678205
Entity Type Code : Organization
Provider Name (Legal Business Name) : FLORIDA DEPARTMENT OF HEALTH
Provider Business Mailing Address
First Line : PO BOX 29
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33402-0029
Country : US
Telephone Number : 561-514-5360
Fax Number : 561-514-5550
Provider Business Practice Location Address
First Line : 1150 45TH ST
Second Line : ROOM L-200
City : WEST PALM BEACH
State : FL
Zip : 33407-2361
Country : US
Telephone Number : 561-514-5360
Fax Number : 561-514-5550
Authorized Official
Title or Position : BIOLOGICAL ADMINISTRATOR III
Name : MR. JESUS EDGARDO DIAZ
Credential :
Telephone Number : 561-514-5360
Provider Enumeration Date : 04/14/2006
Last Update Date : 10/01/2015

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Directions to “FLORIDA DEPARTMENT OF HEALTH ” Practice Location

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