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General NPI Number Information
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NPI Number | 1003244880
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Entity Type | Organization
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Legal Business Name | BANDAR ENTERPRISES LLC SERIES 1 ASSURITY LABS
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 6140 S FORT APACHE ROAD SUITE #140
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City | LAS VEGAS
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State | NV
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Zip | 89148
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Country | US
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Telephone | 702-749-5588
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Fax | 702-852-0396
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Provider Business Mailing Address
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Address Line | 8876 SPANISH RIDGE AVE STE 200
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City | LAS VEGAS
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State | NV
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Zip | 89148-1502
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Country | US
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Telephone | 702-749-5588
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Fax | 702-852-0396
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Authorized Official
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Title or Position | LICENSED LAB DIRECTOR
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Name | MR. ALEXANDER STOJANOFF
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Credential | PHD
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Telephone | 702-749-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 32514DIR-0
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License Number State | NV
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