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General NPI Number Information
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NPI Number | 1144987348
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Entity Type | Organization
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Legal Business Name | VESTRA LABS CA
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Dates
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Enumeration Date | 11/22/2021
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Last Update Date | 11/22/2021
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Provider Practice Location Address
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Address Line | 2432 W PEORIA AVE STE 1327
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City | PHOENIX
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State | AZ
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Zip | 85029-4741
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Country | US
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Telephone | 602-334-1390
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Fax |
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Provider Business Mailing Address
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Address Line | 2432 W PEORIA AVE STE 1327
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City | PHOENIX
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State | AZ
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Zip | 85029-4741
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Country | US
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Telephone | 602-334-1390
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | OLIVIA STAPLES
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Credential |
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Telephone | 480-476-5276
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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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