Healthcare Provider Details

I. General information

NPI: 1285545640
Provider Name (Legal Business Name): AUTISM DIAGNOSTICS LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 E BELL RD STE 4100
PHOENIX AZ
85032-2172
US

IV. Provider business mailing address

3805 E BELL RD STE 4100
PHOENIX AZ
85032-2172
US

V. Phone/Fax

Practice location:
  • Phone: 888-650-0199
  • Fax: 888-804-0426
Mailing address:
  • Phone: 888-650-0199
  • Fax: 888-804-0426

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: FREEDY BRUCE
Title or Position: MANAGER
Credential:
Phone: 888-650-0993