Provider Demographics
NPI:1285045153
Name:MEDICAL TOX LABS, LLC
Entity Type:Organization
Organization Name:MEDICAL TOX LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:GARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-549-2134
Mailing Address - Street 1:PO BOX 205217
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-5217
Mailing Address - Country:US
Mailing Address - Phone:813-549-2134
Mailing Address - Fax:813-870-1383
Practice Address - Street 1:3450 E FLETCHER AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4655
Practice Address - Country:US
Practice Address - Phone:813-549-2134
Practice Address - Fax:813-870-1383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104904200Medicaid