Healthcare Provider Details

I. General information

NPI: 1063388460
Provider Name (Legal Business Name): YSENTIAL DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7922 CANDLEGLOW LN
LOUISVILLE KY
40214-5617
US

IV. Provider business mailing address

7922 CANDLEGLOW LN
LOUISVILLE KY
40214-5617
US

V. Phone/Fax

Practice location:
  • Phone: 502-654-4621
  • Fax:
Mailing address:
  • Phone: 502-654-4621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: YAILENIS MESA GOMEZ
Title or Position: OWNER
Credential:
Phone: 502-654-4621