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General NPI Number Information
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NPI Number | 1780552893
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Entity Type | Organization
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Legal Business Name | PRADUS CLINICAL DX LLC
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 2840 BILL OWENS PKWY STE D
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City | LONGVIEW
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State | TX
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Zip | 75605-2150
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Country | US
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Telephone | 213-476-9779
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Fax |
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Provider Business Mailing Address
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Address Line | 2840 BILL OWENS PKWY STE D
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City | LONGVIEW
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State | TX
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Zip | 75605-2150
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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 | OWNER
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Name | ANSAR JAVED DHILLOU
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Credential |
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Telephone | 213-476-9779
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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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