MEDICARE: FVT LAB CORP

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	305S00000X	Point of Service	601073-0	FL

General Provider Information

NPI Number	:	1851573398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FVT LAB CORP

Provider Business Mailing Address
First Line	:	15668 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-1923
Country	:	US
Telephone Number	:	305-386-0323
Fax Number	:	305-386-0242

Provider Business Practice Location Address
First Line	:	15668 SW 72ND ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33193-1923
Country	:	US
Telephone Number	:	305-386-0323
Fax Number	:	305-386-0242

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FABIANO SILVA
Credential	:
Telephone Number	:	305-386-0323

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	11/27/2007

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Directions to “FVT LAB CORP ” Practice Location

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