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General NPI Number Information
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NPI Number | 1710769039
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Entity Type | Organization
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Legal Business Name | LUXURIOUS LAB TESTING LLC
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Dates
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Enumeration Date | 10/20/2023
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Last Update Date | 08/16/2025
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Provider Practice Location Address
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Address Line | 5108 W GORE BLVD STE 1
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City | LAWTON
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State | OK
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Zip | 73505-6025
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Country | US
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Telephone | 866-278-5565
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Fax | 682-704-2317
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Provider Business Mailing Address
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Address Line | 6112 MCCART AVE
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City | FORT WORTH
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State | TX
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Zip | 76133-3381
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Country | US
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Telephone | 866-278-5565
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Fax |
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Authorized Official
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Title or Position | LAB DIRECTOR
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Name | DEONDRALIQUE GREENE
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Credential | NRCMA
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Telephone | 817-401-7344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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