Provider Demographics
NPI:1184209421
Name:POSEIDON DIAGNOSTICS CORP
Entity Type:Organization
Organization Name:POSEIDON DIAGNOSTICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HUASCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RIJSSENBEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-903-2303
Mailing Address - Street 1:4331 SW 132ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2065 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4901
Practice Address - Country:US
Practice Address - Phone:844-425-2272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory