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General NPI Number Information
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NPI Number | 1821824442
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Entity Type | Organization
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Legal Business Name | EVIA DIAGNOSTICS MARIN LLC
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 4340 REDWOOD HWY STE A33
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City | SAN RAFAEL
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State | CA
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Zip | 94903-2121
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Country | US
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Telephone | 415-475-4620
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Fax |
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Provider Business Mailing Address
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Address Line | 446 OLD COUNTY RD STE 100-340
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City | PACIFICA
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State | CA
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Zip | 94044-3270
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Country | US
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Telephone | 415-475-4620
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAYA PATEL
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Credential |
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Telephone | 415-475-4620
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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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