Healthcare Provider Details

I. General information

NPI: 1609410042
Provider Name (Legal Business Name): PRECISION LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 W GUADALUPE RD STE 120
GILBERT AZ
85233-3056
US

IV. Provider business mailing address

1450 W GUADALUPE RD STE 120
GILBERT AZ
85233-3056
US

V. Phone/Fax

Practice location:
  • Phone: 602-283-3341
  • Fax: 480-590-3543
Mailing address:
  • Phone: 602-283-3341
  • Fax: 480-590-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DAVID CORMIER
Title or Position: OWNER
Credential:
Phone: 480-306-7227