Healthcare Provider Details

I. General information

NPI: 1679235782
Provider Name (Legal Business Name): AVEM DIAGNOSTICS L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 WYNN RD STE D
LAS VEGAS NV
89118-2355
US

IV. Provider business mailing address

5670 WYNN RD STE D
LAS VEGAS NV
89118-2355
US

V. Phone/Fax

Practice location:
  • Phone: 833-693-2898
  • Fax:
Mailing address:
  • Phone: 833-693-2898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. TAMMY LUTTRELL
Title or Position: CHIEF SCIENTIFIC OFFICE
Credential: PHD, PT, CBT, CWS,
Phone: 338-957-0079