Healthcare Provider Details

I. General information

NPI: 1437710415
Provider Name (Legal Business Name): STAGEZERO LIFE SCIENCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8751 PARK CENTRAL DR STE 200
RICHMOND VA
23227-1162
US

IV. Provider business mailing address

8751 PARK CENTRAL DR STE 200
RICHMOND VA
23227-1162
US

V. Phone/Fax

Practice location:
  • Phone: 804-261-3340
  • Fax: 804-515-7291
Mailing address:
  • Phone: 804-261-3340
  • Fax: 804-515-7291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ALFONSO CAMARENA JR.
Title or Position: CONTROLLER
Credential:
Phone: 530-237-7910