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General NPI Number Information
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NPI Number | 1245767870
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Entity Type | Organization
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Legal Business Name | PEDIALABS, LLC
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Dates
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Enumeration Date | 05/14/2017
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Last Update Date | 08/25/2021
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Provider Practice Location Address
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Address Line | 4653 S LAKESHORE DR STE 1
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City | TEMPE
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State | AZ
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Zip | 85282-7161
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Country | US
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Telephone | 480-395-3972
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Fax | 480-503-8138
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Provider Business Mailing Address
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Address Line | 4653 S LAKESHORE DR STE 1
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City | TEMPE
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State | AZ
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Zip | 85282-7161
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Country | US
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Telephone | 480-395-3972
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Fax | 480-503-8138
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Authorized Official
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Title or Position | OWNER
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Name | MARIA STEWART ATKINS
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Credential |
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Telephone | 252-468-2917
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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 | 299660
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License Number State | AZ
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