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General NPI Number Information
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NPI Number | 1104285071
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Entity Type | Organization
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Legal Business Name | DILIGENT DIAGNOSTIC
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Dates
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Enumeration Date | 02/19/2016
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Last Update Date | 02/19/2016
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Provider Practice Location Address
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Address Line | 11051 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85029-4816
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Country | US
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Telephone | 702-415-3716
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Fax | 702-479-1793
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Provider Business Mailing Address
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Address Line | 11051 N 19TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85029-4816
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Country | US
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Telephone | 702-415-3716
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Fax | 702-479-1793
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MICHAEL FITCH
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Credential |
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Telephone | 702-415-3716
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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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