Provider Demographics
NPI:1720737653
Name:CHARLES DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:CHARLES DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANIDE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-800-3510
Mailing Address - Street 1:1530 W BOYNTON BEACH BLVD # 4324
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-4606
Mailing Address - Country:US
Mailing Address - Phone:561-291-7016
Mailing Address - Fax:
Practice Address - Street 1:10062 STONEHENGE CIR APT 119
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3539
Practice Address - Country:US
Practice Address - Phone:561-291-7016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory