MEDICARE: CEDAR DIAGNOSTICS 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	:	1548009327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEDAR DIAGNOSTICS LLC

Provider Business Mailing Address
First Line	:	1464 E WHITESTONE BLVD STE 2101
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-9079
Country	:	US
Telephone Number	:	510-585-7635
Fax Number	:

Provider Business Practice Location Address
First Line	:	1464 E WHITESTONE BLVD STE 2101
Second Line	:
City	:	CEDAR PARK
State	:	TX
Zip	:	78613-9079
Country	:	US
Telephone Number	:	510-585-7635
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	ALI ASHMAIG
Credential	:
Telephone Number	:	510-585-7635

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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