Provider Demographics
NPI:1952823304
Name:CAPITAL ADVANTAGE DIAGNOSTICS
Entity Type:Organization
Organization Name:CAPITAL ADVANTAGE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PUGLIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-201-8850
Mailing Address - Street 1:1860 OKEECHOBEE RD STE 510
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-5242
Mailing Address - Country:US
Mailing Address - Phone:561-619-6351
Mailing Address - Fax:
Practice Address - Street 1:1860 OKEECHOBEE RD STE 510
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-5242
Practice Address - Country:US
Practice Address - Phone:561-619-6351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27580OtherCOLA
FL10D2130090OtherCLIA