Provider Demographics
NPI:1639466063
Name:ANY LAB TEST FAST
Entity Type:Organization
Organization Name:ANY LAB TEST FAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOS/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINNAVARIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-456-3317
Mailing Address - Street 1:14055 WEST DIXIE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3442
Mailing Address - Country:US
Mailing Address - Phone:305-456-3317
Mailing Address - Fax:305-456-9219
Practice Address - Street 1:14055 WEST DIXIE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-3442
Practice Address - Country:US
Practice Address - Phone:305-456-3317
Practice Address - Fax:305-456-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13-64-1351067291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D2024732Medicaid