Healthcare Provider Details

I. General information

NPI: 1164338323
Provider Name (Legal Business Name): PHOENIX DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE. SUITE 300 OFFICE 325
PHOENIX AZ
85013-3420
US

IV. Provider business mailing address

300 W CLARENDON AVE. SUITE 300 OFFICE 325
PHOENIX AZ
85013-3420
US

V. Phone/Fax

Practice location:
  • Phone: 929-802-0684
  • Fax: 213-933-8718
Mailing address:
  • Phone: 929-802-0684
  • Fax: 213-933-8718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMAD MANSOOR
Title or Position: OWNER
Credential:
Phone: 929-802-0684