MEDICARE: RAPID LAB

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician

General Provider Information

NPI Number	:	1235727546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAPID LAB

Provider Business Mailing Address
First Line	:	2464 REYNOLDS AVE
Second Line	:	SUITE 202
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030
Country	:	US
Telephone Number	:	909-556-2644
Fax Number	:	702-780-5840

Provider Business Practice Location Address
First Line	:	2464 REYNOLDS AVE
Second Line	:	SUITE 202
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030
Country	:	US
Telephone Number	:	909-556-2644
Fax Number	:	702-780-5840

Authorized Official
Title or Position	:	CREDENTIALING DEPARTMENT
Name	:	CARMEN Z COLON
Credential	:
Telephone Number	:	702-772-9755

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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