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General NPI Number Information
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NPI Number | 1245040252
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Entity Type | Organization
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Legal Business Name | THRIVELAB LLC
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Dates
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Enumeration Date | 01/10/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 23276 S POINTE DR STE 101
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1430
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Country | US
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Telephone | 949-749-2165
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Fax |
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Provider Business Mailing Address
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Address Line | 23276 S POINTE DR STE 101
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1430
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Country | US
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Telephone | 949-749-2165
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ASSAL RAD
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Credential |
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Telephone | 949-749-2165
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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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