Healthcare Provider Details

I. General information

NPI: 1255260121
Provider Name (Legal Business Name): VENI VIDI VICI PRIVATE LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43834 3RD ST E
LANCASTER CA
93535-4008
US

IV. Provider business mailing address

43834 3RD ST E
LANCASTER CA
93535-4008
US

V. Phone/Fax

Practice location:
  • Phone: 747-786-4622
  • Fax:
Mailing address:
  • Phone: 747-786-4622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: TIFFANI DENICE FOUSR
Title or Position: PHLEBOTOMIST
Credential: CPT
Phone: 747-786-4622