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Organization
ICON LABS INC.
Active
Organization
ICON LABS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIVINA BRINKLEY (PRESIDENT)
(954) 854-8971
Entity
Organization
Contact information
Practice address
4891 NW 103RD AVE STE 11J, SUNRISE, FL 33351-7955
(954) 854-8971
Mailing address
5944 CORAL RIDGE DR # 246, CORAL SPRINGS, FL 33076-3300
(954) 854-8971
Taxonomy
Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
—
NULL
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary
—
—
Other
Enumeration date
01/09/2023
Last updated
01/09/2023
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