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General NPI Number Information
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NPI Number | 1700521630
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Entity Type | Organization
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Legal Business Name | TESIS LABS OF ARIZONA LLC
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Dates
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Enumeration Date | 05/04/2022
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 8125 N 86TH PL
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4310
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Country | US
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Telephone | 480-454-4594
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Fax |
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Provider Business Mailing Address
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Address Line | 107 PROSPECT ST STE 2
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City | SCHOHARIE
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State | NY
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Zip | 12157-3204
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Country | US
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Telephone | 480-454-4594
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN GREGG GAUTEREAUX
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Credential |
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Telephone | 480-818-7598
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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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