Provider Demographics
NPI:1508681123
Name:GL CLINICAL LABORATORY AND RESEARCH LLC
Entity type:Organization
Organization Name:GL CLINICAL LABORATORY AND RESEARCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-870-5588
Mailing Address - Street 1:7911 NW 72ND AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33166-2221
Mailing Address - Country:US
Mailing Address - Phone:786-870-5588
Mailing Address - Fax:
Practice Address - Street 1:7911 NW 72ND AVE STE 115
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2221
Practice Address - Country:US
Practice Address - Phone:786-870-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory