Healthcare Provider Details

I. General information

NPI: 1104735844
Provider Name (Legal Business Name): BOSTON LESJAK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR STE 21566
AUSTIN TX
78731-4257
US

IV. Provider business mailing address

5900 BALCONES DR STE 21566
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 481-623-7123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL

VIII. Authorized Official

Name: BOSTON DANIEL LESJAK
Title or Position: CEO
Credential:
Phone: 781-237-6128