Provider Demographics
NPI:1306443320
Name:BODYWINS LLC
Entity type:Organization
Organization Name:BODYWINS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT & CHIEF OF STAFF
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:LASSO
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:954-951-1539
Mailing Address - Street 1:2930 NW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3664
Mailing Address - Country:US
Mailing Address - Phone:954-667-7908
Mailing Address - Fax:
Practice Address - Street 1:3221 NW 10TH TER STE 508
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-5942
Practice Address - Country:US
Practice Address - Phone:954-667-7908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory