Provider Demographics
NPI:1386687994
Name:REGISTERED ELECTRODIAGNOSTIC MOBIL LAB INC
Entity Type:Organization
Organization Name:REGISTERED ELECTRODIAGNOSTIC MOBIL LAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:A
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-5548
Mailing Address - Street 1:1490 W 49 PL
Mailing Address - Street 2:SUITE 552
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3148
Mailing Address - Country:US
Mailing Address - Phone:305-558-5548
Mailing Address - Fax:305-558-5824
Practice Address - Street 1:1490 W 49 PL
Practice Address - Street 2:SUITE 552
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3148
Practice Address - Country:US
Practice Address - Phone:305-558-5548
Practice Address - Fax:305-558-5824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246ZE066000X246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE9110Medicare PIN