Provider Demographics
NPI:1508133372
Name:LODDSTONE LAB GROUP OF FLORIDA
Entity Type:Organization
Organization Name:LODDSTONE LAB GROUP OF FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUREIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-236-3879
Mailing Address - Street 1:409 W HALLANDALE BEACH BLVD
Mailing Address - Street 2:# 208
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5301
Mailing Address - Country:US
Mailing Address - Phone:786-236-3879
Mailing Address - Fax:954-457-8111
Practice Address - Street 1:409 W HALLANDALE BEACH BLVD
Practice Address - Street 2:# 208
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5301
Practice Address - Country:US
Practice Address - Phone:786-236-3879
Practice Address - Fax:954-457-8111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800026240291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory