Provider Demographics
NPI:1336483270
Name:QUANTUM LABORATORIES, INC
Entity Type:Organization
Organization Name:QUANTUM LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DE LA GANDARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-687-2111
Mailing Address - Street 1:2161 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6607
Mailing Address - Country:US
Mailing Address - Phone:561-687-2111
Mailing Address - Fax:561-687-1777
Practice Address - Street 1:2161 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6607
Practice Address - Country:US
Practice Address - Phone:561-687-2111
Practice Address - Fax:561-687-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch