Healthcare Provider Details

I. General information

NPI: 1407781578
Provider Name (Legal Business Name): ACUVERA LAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE STE C304
PHOENIX AZ
85051-9624
US

IV. Provider business mailing address

10000 N 31ST AVE STE C304
PHOENIX AZ
85051-9624
US

V. Phone/Fax

Practice location:
  • Phone: 832-919-2652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: SANDYA MALOTH
Title or Position: PRESIDENT
Credential:
Phone: 832-919-2652