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General NPI Number Information
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NPI Number | 1285316075
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Entity Type | Organization
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Legal Business Name | EXEVIA DIAGNOSTICS LLC
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 03/13/2026
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Provider Practice Location Address
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Address Line | 771 E SOUTHLAKE BLVD STE 217
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6989
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Country | US
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Telephone | 469-638-8875
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Fax |
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Provider Business Mailing Address
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Address Line | 771 E SOUTHLAKE BLVD STE 217
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6989
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Country | US
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Telephone | 303-228-6119
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANI PETROSYAN
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Credential |
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Telephone | 303-228-6119
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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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