Provider Demographics
NPI:1922007947
Name:UNILAB OF DADE INC
Entity Type:Organization
Organization Name:UNILAB OF DADE INC
Other - Org Name:UNILAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORTES
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS
Authorized Official - Phone:954-792-7422
Mailing Address - Street 1:2145 DAVIE BLVD
Mailing Address - Street 2:#106
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-3161
Mailing Address - Country:US
Mailing Address - Phone:954-792-7422
Mailing Address - Fax:954-797-9494
Practice Address - Street 1:2145 DAVIE BLVD
Practice Address - Street 2:#106
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-3161
Practice Address - Country:US
Practice Address - Phone:954-792-7422
Practice Address - Fax:954-797-9494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10D0284855291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10D0284855OtherCLIA #