Healthcare Provider Details

I. General information

NPI: 1376038950
Provider Name (Legal Business Name): DBW DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 W SIERRA ST
PHOENIX AZ
85029-3425
US

IV. Provider business mailing address

2414 W SIERRA ST
PHOENIX AZ
85029-3425
US

V. Phone/Fax

Practice location:
  • Phone: 719-581-9252
  • Fax: 928-255-4817
Mailing address:
  • Phone: 719-581-9252
  • Fax: 928-255-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number1134373
License Number StateAZ

VIII. Authorized Official

Name: CASSANDRA SMITH
Title or Position: BUSINESS MANAGER
Credential:
Phone: 719-581-9252