MEDICARE: IMPERIAL LABS

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	:	1518429703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL LABS

Provider Business Mailing Address
First Line	:	2950 S RAINBOW BLVD STE 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6213
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2950 S RAINBOW BLVD STE 260
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-6213
Country	:	US
Telephone Number	:	702-302-9717
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MISS YULIA LEONTIEVA
Credential	:
Telephone Number	:	702-302-9717

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	06/11/2019

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Directions to “IMPERIAL LABS ” Practice Location

Language	Start Address	Practice Location

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