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NPI Code Detail

MEDICARE: THRIVELAB LLC

MEDICARE: THRIVELAB LLC
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
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CLF-90012746OTHERCACDPH LFS
205D2304140OTHERCLIA

General Provider Information

NPI Number : 1245040252
Entity Type Code : Organization
Provider Name (Legal Business Name) : THRIVELAB LLC
Provider Business Mailing Address
First Line : 23276 S POINTE DR STE 101
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-1430
Country : US
Telephone Number : 949-749-2165
Fax Number :
Provider Business Practice Location Address
First Line : 23276 S POINTE DR STE 101
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-1430
Country : US
Telephone Number : 949-749-2165
Fax Number :
Authorized Official
Title or Position : CEO
Name : ASSAL RAD
Credential :
Telephone Number : 949-749-2165
Provider Enumeration Date : 01/10/2025
Last Update Date : 01/13/2025

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