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General NPI Number Information
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NPI Number | 1558348151
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Entity Type | Organization
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Legal Business Name | LAKE HAVASU MEDICAL LABORATORY,LTD.
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1951 MESQUITE AVE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5746
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Country | US
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Telephone | 928-855-4077
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Fax | 928-855-5470
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Provider Business Mailing Address
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Address Line | 1951 MESQUITE AVE
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86403-5746
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Country | US
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Telephone | 928-855-4077
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Fax | 928-855-5470
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. GWENNA J MARQUIS
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Credential | CLS(NCA)
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Telephone | 928-855-4077
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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 | AZ
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