Provider Demographics
NPI:1821836347
Name:ADVANCED ARTISTS ONCOSURE TESTING LLC
Entity type:Organization
Organization Name:ADVANCED ARTISTS ONCOSURE TESTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VITULANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-310-5084
Mailing Address - Street 1:1550 N ANDREWS AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-1735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1550 N ANDREWS AVENUE EXT
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-1735
Practice Address - Country:US
Practice Address - Phone:754-310-5084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty