MEDICARE: MARBELLA OASES INC

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

General Provider Information

NPI Number	:	1609251214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARBELLA OASES INC

Provider Business Mailing Address
First Line	:	2238 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-4705
Country	:	US
Telephone Number	:	561-330-4752
Fax Number	:	561-660-4765

Provider Business Practice Location Address
First Line	:	2238 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-4705
Country	:	US
Telephone Number	:	561-330-4752
Fax Number	:	561-660-4765

Authorized Official
Title or Position	:	OFFICER
Name	:	BASIM ELHABASHY
Credential	:	M.D.
Telephone Number	:	561-330-4752

Provider Enumeration Date	:	07/24/2015
Last Update Date	:	07/24/2015

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