Healthcare Provider Details

I. General information

NPI: 1497449383
Provider Name (Legal Business Name): STAMP OF APPROVAL STAT LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 06/21/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 WEAVER DRIVE
LAS VEGAS NV
89106
US

IV. Provider business mailing address

3172 N RAINBOW BLVD # 5077
LAS VEGAS NV
89108-4534
US

V. Phone/Fax

Practice location:
  • Phone: 702-472-3791
  • Fax:
Mailing address:
  • Phone: 702-472-3791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: TINA RANE' INGRAM
Title or Position: OWNER
Credential: CNA
Phone: 702-472-3791