Organization
FLORIDA DEPARTMENT OF HEALTH
Active
Other names
PBCHD Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESUS EDGARDO DIAZ (BIOLOGICAL ADMINISTRATOR III)
(561) 514-5360
Entity
Organization
Contact information
Practice address
1150 45TH ST, ROOM L-200, WEST PALM BEACH, FL 33407-2361
(561) 514-5360
(561) 514-5550
Mailing address
PO BOX 29, WEST PALM BEACH, FL 33402-0029
(561) 514-5360
(561) 514-5550
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800001191
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030448400
—
FL
Enumeration date
04/14/2006
Last updated
10/01/2015
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