MEDICARE: COMMUNITY MEDICAL LABORATORIES,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	03D2085740	AZ

General Provider Information

NPI Number	:	1760887814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEDICAL LABORATORIES,LLC

Provider Business Mailing Address
First Line	:	1330 W AUTO DR STE 202
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 W AUTO DR STE 202
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85284-1017
Country	:	US
Telephone Number	:	602-276-1651
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	FRANCISCO R DIAZ
Credential	:
Telephone Number	:	602-276-1651

Provider Enumeration Date	:	10/31/2014
Last Update Date	:	10/31/2014

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