Healthcare Provider Details

I. General information

NPI: 1518619691
Provider Name (Legal Business Name): TRULAB DIAGNOSTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 BAKER RD
INDEPENDENCE LA
70443-4742
US

IV. Provider business mailing address

178 BAKER RD
INDEPENDENCE LA
70443-4742
US

V. Phone/Fax

Practice location:
  • Phone: 985-474-2114
  • Fax: 985-247-2254
Mailing address:
  • Phone: 985-474-2114
  • Fax: 985-247-2254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: REGINA R NICHOLES
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 985-474-2114