Provider Demographics
NPI:1275547192
Name:MED HEALTH CLINICAL LAB LLC
Entity Type:Organization
Organization Name:MED HEALTH CLINICAL LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRETHEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RABASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-592-2888
Mailing Address - Street 1:1414 NW 107TH AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2732
Mailing Address - Country:US
Mailing Address - Phone:305-592-2888
Mailing Address - Fax:305-592-2666
Practice Address - Street 1:1414 NW 107TH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2732
Practice Address - Country:US
Practice Address - Phone:305-592-2888
Practice Address - Fax:305-592-2666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory