Provider Demographics
NPI:1114976784
Name:MARBE LABS
Entity Type:Organization
Organization Name:MARBE LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:IVANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-989-3793
Mailing Address - Street 1:6303 SW 116TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4770
Mailing Address - Country:US
Mailing Address - Phone:305-989-3793
Mailing Address - Fax:305-271-8074
Practice Address - Street 1:6303 SW 116TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4796
Practice Address - Country:US
Practice Address - Phone:305-989-3793
Practice Address - Fax:305-271-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE2295Medicare ID - Type Unspecified