Provider Demographics
NPI:1659960730
Name:IMPERIAL LABS LLC
Entity Type:Organization
Organization Name:IMPERIAL LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOFFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-465-2089
Mailing Address - Street 1:5530 LONG PRAIRIE TRCE STE 400
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2331
Mailing Address - Country:US
Mailing Address - Phone:954-465-2089
Mailing Address - Fax:
Practice Address - Street 1:5530 LONG PRAIRIE TRCE STE 400
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2331
Practice Address - Country:US
Practice Address - Phone:954-465-2089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory