Provider Demographics
NPI:1447282892
Name:FLORIDA REFERENCE LABORATORY INC
Entity type:Organization
Organization Name:FLORIDA REFERENCE LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:VICENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-662-2626
Mailing Address - Street 1:7109 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4607
Mailing Address - Country:US
Mailing Address - Phone:305-662-2626
Mailing Address - Fax:305-667-5870
Practice Address - Street 1:7109 SW 43RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4607
Practice Address - Country:US
Practice Address - Phone:305-662-2626
Practice Address - Fax:305-667-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE9008Medicare PIN