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General NPI Number Information
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NPI Number | 1437509858
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Entity Type | Organization
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Legal Business Name | NOVA LABS, LLC
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 1050 LAS TABLAS RD STE 14
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City | TEMPLETON
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State | CA
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Zip | 93465-9729
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Country | US
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Telephone | 877-230-1518
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Fax |
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Provider Business Mailing Address
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Address Line | 6006 N MESA ST STE 511
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City | EL PASO
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State | TX
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Zip | 79912-4630
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | BLAKE ANDERSON
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Credential |
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Telephone | 805-600-1704
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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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