Provider Demographics
NPI:1982604070
Name:CRONOS CLINICAL LABORATORY
Entity Type:Organization
Organization Name:CRONOS CLINICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-592-2503
Mailing Address - Street 1:2650 NW 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1400
Mailing Address - Country:US
Mailing Address - Phone:305-592-2503
Mailing Address - Fax:
Practice Address - Street 1:2650 NW 97TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1400
Practice Address - Country:US
Practice Address - Phone:305-592-2503
Practice Address - Fax:305-592-2663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-29
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL800019596291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031396300Medicaid
FLE9157Medicare ID - Type Unspecified