Provider Demographics
NPI:1407113020
Name:LABORATORY OF FLORIDA LLC
Entity Type:Organization
Organization Name:LABORATORY OF FLORIDA LLC
Other - Org Name:LABFLORIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-472-7772
Mailing Address - Street 1:903 MOORING CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5757
Mailing Address - Country:US
Mailing Address - Phone:813-472-7772
Mailing Address - Fax:813-472-7778
Practice Address - Street 1:7520 W WATERS AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1599
Practice Address - Country:US
Practice Address - Phone:813-885-7755
Practice Address - Fax:813-885-6688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory