Healthcare Provider Details

I. General information

NPI: 1346994985
Provider Name (Legal Business Name): EMBRY TESTING AND VACCINE SERVICES OF NEVADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 E HILTON AVE STE 250
PHOENIX AZ
85034-6400
US

IV. Provider business mailing address

PO BOX 62043
PHOENIX AZ
85082-2043
US

V. Phone/Fax

Practice location:
  • Phone: 480-701-3322
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND EMBRY
Title or Position: CEO
Credential:
Phone: 480-376-2170