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General NPI Number Information
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NPI Number | 1841724895
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Entity Type | Organization
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Legal Business Name | PMDLAB, LLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 4630 NORTHGATE BLVD STE 150
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City | SACRAMENTO
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State | CA
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Zip | 95834-1141
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Country | US
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Telephone | 916-776-8240
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Fax | 916-597-1379
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Provider Business Mailing Address
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Address Line | 3440 N 16TH ST STE 200
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City | PHOENIX
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State | AZ
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Zip | 85016-7125
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Country | US
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Telephone | 781-626-1212
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | PETER SIMMONS
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Credential |
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Telephone | 781-626-1212
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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 | CLF 11680
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License Number State | CA
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