Organization
ANGEL WINGS DIAGNOSTIC LABS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATRAVIA ANTINETTE CLAYTON (OWNER/MANAGER)
(786) 521-4206
Entity
Organization
Contact information
Practice address
4330 W BROWARD BLVD STE O, PLANTATION, FL 33317-3754
(786) 521-4206
Mailing address
4351 NW 15TH ST, LAUDERHILL, FL 33313-5709
(786) 521-4206
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
10/13/2021
Last updated
10/13/2021
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