=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760343305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVA DIAGNOSTIC LAB INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2025
-----------------------------------------------------
Last Update Date | 12/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13610 MIDWAY RD STE 260
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-4347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-258-6965
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13610 MIDWAY RD STE 260
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-4347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-272-3125
-----------------------------------------------------
Fax | 214-258-6965
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ANDRANIK DAVITYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-272-3125
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246RM2200X
-----------------------------------------------------
Taxonomy Name | Medical Laboratory Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------