Provider Demographics
NPI:1447713128
Name:SPECTRUM DIAGNOSTICS LLC
Entity type:Organization
Organization Name:SPECTRUM DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALVIS
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:PUGLIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-779-3711
Mailing Address - Street 1:5283 W ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-8134
Mailing Address - Country:US
Mailing Address - Phone:877-779-3711
Mailing Address - Fax:888-726-8451
Practice Address - Street 1:823 SE OSCEOLA ST STE 5
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2431
Practice Address - Country:US
Practice Address - Phone:877-779-3711
Practice Address - Fax:888-726-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29449OtherCOLA
FL10D2164100OtherCLIA