Healthcare Provider Details

I. General information

NPI: 1801487830
Provider Name (Legal Business Name): COLECTIVO LABORATORIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10385 E DREYFUS AVE
SCOTTSDALE AZ
85260-7287
US

IV. Provider business mailing address

10385 E DREYFUS AVE
SCOTTSDALE AZ
85260-7287
US

V. Phone/Fax

Practice location:
  • Phone: 480-529-3859
  • Fax:
Mailing address:
  • Phone: 480-529-3859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH TRUAX
Title or Position: PRESIDENT / CEO
Credential:
Phone: 480-529-3859