Provider Demographics
NPI:1366021883
Name:TRIKALA LABORATORIES A LLC
Entity type:Organization
Organization Name:TRIKALA LABORATORIES A LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-885-8472
Mailing Address - Street 1:15275 COLLIER BLVD STE 201-436
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-6750
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24850 OLD 41 RD STE 16
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7087
Practice Address - Country:US
Practice Address - Phone:888-885-8472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory