Healthcare Provider Details

I. General information

NPI: 1750124830
Provider Name (Legal Business Name): QUANTUMLAB INNOVATIVE SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 FACTORIA BLVD SE APT 210
BELLEVUE WA
98006-1910
US

IV. Provider business mailing address

4220 FACTORIA BLVD SE APT 210
BELLEVUE WA
98006-1910
US

V. Phone/Fax

Practice location:
  • Phone: 888-522-7443
  • Fax:
Mailing address:
  • Phone: 253-436-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: EBONY GUTHRIE
Title or Position: CEO
Credential: CPT II, AHI
Phone: 888-522-7443