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General NPI Number Information
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NPI Number | 1457651952
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Entity Type | Organization
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Legal Business Name | LABORATORY SERVICES OF NEVADA, LLC
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Dates
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Enumeration Date | 10/30/2010
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Last Update Date | 10/30/2010
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Provider Practice Location Address
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Address Line | 3376 S EASTERN AVE STE 170
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City | LAS VEGAS
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State | NV
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Zip | 89169-3397
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Country | US
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Telephone | 702-684-6000
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Fax | 702-684-6002
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Provider Business Mailing Address
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Address Line | 3376 S EASTERN AVE STE 170
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City | LAS VEGAS
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State | NV
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Zip | 89169-3397
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Country | US
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Telephone | 702-684-6000
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Fax | 702-684-6002
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. RAKESH KUTHURU
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Credential |
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Telephone | 315-857-3648
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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 | 5562LIC
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License Number State | NV
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