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General NPI Number Information
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NPI Number | 1053775965
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Entity Type | Organization
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Legal Business Name | LUX LABORATORIES LLC
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 09/11/2017
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Provider Practice Location Address
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Address Line | 2851 EL CAMINO AVE STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89102-4266
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Country | US
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Telephone | 702-380-3210
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Fax | 702-380-3212
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Provider Business Mailing Address
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Address Line | 2851 EL CAMINO AVE SUITE 200
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City | LAS VEGAS
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State | NV
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Zip | 89102-4266
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Country | US
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Telephone | 702-380-3210
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Fax | 702-380-3212
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | STACY E FLATT
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Credential |
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Telephone | 702-401-4483
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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 | NV20161197177
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License Number State | NV
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