MEDICARE: ACUVERA LAB 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
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1407781578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUVERA LAB LLC

Provider Business Mailing Address
First Line	:	10000 N 31ST AVE STE C304
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9624
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 N 31ST AVE STE C304
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9624
Country	:	US
Telephone Number	:	832-919-2652
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANDYA MALOTH
Credential	:
Telephone Number	:	832-919-2652

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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Directions to “ACUVERA LAB LLC ” Practice Location

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