Healthcare Provider Details

I. General information

NPI: 1114868619
Provider Name (Legal Business Name): TECH VERGE LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 19TH ST STE 100
BAKERSFIELD CA
93301-4326
US

IV. Provider business mailing address

1712 19TH ST STE 100
BAKERSFIELD CA
93301-4326
US

V. Phone/Fax

Practice location:
  • Phone: 661-301-9257
  • Fax:
Mailing address:
  • Phone: 661-301-9257
  • 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: AVINASH REDDY PADKANTI
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential:
Phone: 661-301-9257