MEDICARE: PRESTIGE LABS LLC

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
1	291U00000X	Clinical Medical Laboratory		FL

General Provider Information

NPI Number	:	1437692894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESTIGE LABS LLC

Provider Business Mailing Address
First Line	:	PO BOX 13150
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-7150
Country	:	US
Telephone Number	:	954-634-4425
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 SW POMA DR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-6611
Country	:	US
Telephone Number	:	954-634-4425
Fax Number	:

Authorized Official
Title or Position	:	EXEC
Name	:	JOE MONASTRA
Credential	:
Telephone Number	:	954-634-4425

Provider Enumeration Date	:	12/02/2016
Last Update Date	:	12/02/2016

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