Basic Information
| Provider Information | |||||||||
| NPI: | 1245740075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOCA BIOLISTICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 NW 13TH AVE STE H | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330648649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126379861 | ||||||||
| FaxNumber: | 7705739513 | ||||||||
| Practice Location | |||||||||
| Address1: | 5001 NW 13TH AVE STE H | ||||||||
| Address2: | |||||||||
| City: | POMPANO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330648649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126379861 | ||||||||
| FaxNumber: | 7705739513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2017 | ||||||||
| LastUpdateDate: | 10/06/2017 | ||||||||
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| AuthorizedOfficialLastName: | ADIA | ||||||||
| AuthorizedOfficialFirstName: | VALENTIN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 3126379861 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | FL | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.