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General NPI Number Information
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NPI Number | 1083802730
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Entity Type | Organization
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Legal Business Name | ELI-LEO LLC
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 6262 MCPHERSON RD STE# 107
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City | LAREDO
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State | TX
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Zip | 78041-6171
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Country | US
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Telephone | 956-717-2821
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Fax | 956-717-0630
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Provider Business Mailing Address
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Address Line | 6262 MCPHERSON RD STE# 107
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City | LAREDO
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State | TX
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Zip | 78041-6171
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Country | US
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Telephone | 956-717-2821
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Fax | 956-717-0630
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | LEONEL HERNANDEZ
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Credential |
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Telephone | 956-236-9028
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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 | TX
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