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General NPI Number Information
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NPI Number | 1043738503
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Entity Type | Organization
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Legal Business Name | LABRAD DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 01/08/2019
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Provider Practice Location Address
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Address Line | 2050 E UNIVERSITY DR STE 1
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City | PHOENIX
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State | AZ
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Zip | 85034-6700
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Country | US
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Telephone | 602-714-7812
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2135
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City | CHANDLER
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State | AZ
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Zip | 85244-2135
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORGANIZER
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Name | ARIZONA AGENT
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Credential |
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Telephone | 602-714-7812
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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 |
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License Number State |
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