Angel Wings Diagnostic Labs LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

ANGEL WINGS DIAGNOSTIC LABS LLC

Practice address

4330 W Broward Blvd Ste O
Plantation, FL 33317-3754

Phone

(786) 521-4206

NPI assigned

Oct 13, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Latravia Antinette ClaytonNPI 1649938770

Title

Owner/Manager

Phone

(786) 521-4206

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Latravia Antinette Clayton

  • Clinical Medical Laboratory
  • Plantation, FL
  • NPI 1649938770
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634083200000",
    "number": "1346902616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4351 NW 15TH ST",
            "city": "LAUDERHILL",
            "state": "FL",
            "postal_code": "333135709",
            "telephone_number": "786-521-4206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 W BROWARD BLVD STE O",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333173754",
            "telephone_number": "786-521-4206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGEL WINGS DIAGNOSTIC LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-13",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A",
        "authorized_official_last_name": "CLAYTON",
        "authorized_official_first_name": "LATRAVIA",
        "authorized_official_middle_name": "ANTINETTE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "786-521-4206"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Plantation, FL
• Providers in Plantation, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.