MEDICARE: MR. FLORANTE LAMARCA CABALBAG LAB TECH

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	291900000X	Military Clinical Medical Laboratory

General Provider Information

NPI Number	:	1962735944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FLORANTE LAMARCA CABALBAG LAB TECH

Provider Business Mailing Address
First Line	:	2763 S 37TH DR
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-5983
Country	:	US
Telephone Number	:	928-317-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	2763 S 37TH DR
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-5983
Country	:	US
Telephone Number	:	928-317-0062
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2009
Last Update Date	:	09/09/2009

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