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General NPI Number Information
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NPI Number | 1760887814
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Entity Type | Organization
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Legal Business Name | COMMUNITY MEDICAL LABORATORIES,LLC
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Dates
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Enumeration Date | 10/31/2014
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Last Update Date | 10/31/2014
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Provider Practice Location Address
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Address Line | 1330 W AUTO DR STE 202
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City | TEMPE
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State | AZ
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Zip | 85284-1017
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Country | US
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Telephone | 602-276-1651
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 W AUTO DR STE 202
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City | TEMPE
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State | AZ
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Zip | 85284-1017
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | FRANCISCO R DIAZ
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Credential |
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Telephone | 602-276-1651
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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 | 03D2085740
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License Number State | AZ
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