Organization
CLEAN SLATE LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA IACULLO (BILLING DIRECTOR)
(561) 270-2361
Entity
Organization
Contact information
Practice address
118 CANOE DR, WEST PALM BEACH, FL 33415-2602
(561) 270-2361
Mailing address
118 CANOE DR, WEST PALM BEACH, FL 33415-2602
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
10D2063192
FL
Other
Enumeration date
10/24/2013
Last updated
10/24/2013
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