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General NPI Number Information
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NPI Number | 1669079208
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Entity Type | Organization
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Legal Business Name | EXOVA DIAGNOSTICS LLC
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 11331 JAMES WATT DR STE 300A
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City | EL PASO
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State | TX
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Zip | 79936-6401
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Country | US
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Telephone | 503-464-6467
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Fax | 805-591-4810
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Provider Business Mailing Address
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Address Line | 11331 JAMES WATT DR STE 300A
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City | EL PASO
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State | TX
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Zip | 79936-6401
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Country | US
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Telephone | 503-464-6467
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Fax | 805-591-4810
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | BLAKE ANDERSON
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Credential |
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Telephone | 915-471-5360
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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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