1508133372 NPI number — LODDSTONE LAB GROUP OF FLORIDA

Table of content: MISS CUONG KIM TRAN (NPI 1508392184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508133372 NPI number — LODDSTONE LAB GROUP OF FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LODDSTONE LAB GROUP OF FLORIDA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508133372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 W HALLANDALE BEACH BLVD
Provider Second Line Business Mailing Address:
# 208
Provider Business Mailing Address City Name:
HALLANDALE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33009-5301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-236-3879
Provider Business Mailing Address Fax Number:
954-457-8111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 W HALLANDALE BEACH BLVD
Provider Second Line Business Practice Location Address:
# 208
Provider Business Practice Location Address City Name:
HALLANDALE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33009-5301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-236-3879
Provider Business Practice Location Address Fax Number:
954-457-8111
Provider Enumeration Date:
11/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LOUREIRO
Authorized Official First Name:
ANTOINETA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
786-236-3879

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  800026240 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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