Organization
PHYSICIANS STAT LAB INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANCISCO URTEAGA (OWNER)
(305) 496-9038
Entity
Organization
Contact information
Practice address
4290 S HWY 27 STE 204, CLERMONT, FL 34711-8066
(833) 782-8522
Mailing address
4290 S HWY 27 STE 204, CLERMONT, FL 34711-8066
(833) 782-8522
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
L800011974
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119047100
—
FL
01
—
L9069
BCBS
FL
Enumeration date
08/13/2006
Last updated
09/14/2023
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