Provider Demographics
NPI:1154683704
Name:UA SPECIALIST OF THE PALM BEACHES
Entity Type:Organization
Organization Name:UA SPECIALIST OF THE PALM BEACHES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-379-3577
Mailing Address - Street 1:PO BOX 2454
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468-2454
Mailing Address - Country:US
Mailing Address - Phone:561-379-3577
Mailing Address - Fax:
Practice Address - Street 1:105 S WHITNEY DR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4200
Practice Address - Country:US
Practice Address - Phone:561-379-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory