MEDICARE: ABDA LABS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1043050024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABDA LABS, LLC

Provider Business Mailing Address
First Line	:	12150 FLINT PL STE B
Second Line	:
City	:	POWAY
State	:	CA
Zip	:	92064-7106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8006 CAMERON RD STE A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-3810
Country	:	US
Telephone Number	:	512-222-7177
Fax Number	:	737-702-5659

Authorized Official
Title or Position	:	OWNER
Name	:	ROBIN DAVID YAZDI
Credential	:
Telephone Number	:	512-222-7177

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	12/20/2024

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