MEDICARE: MYRO ENTERPRISES CORPORATION

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	:	1548875818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYRO ENTERPRISES CORPORATION

Provider Business Mailing Address
First Line	:	1145 2ND ST # 102
Second Line	:
City	:	BRENTWOOD
State	:	CA
Zip	:	94513-2292
Country	:	US
Telephone Number	:	197-386-8986
Fax Number	:

Provider Business Practice Location Address
First Line	:	3065 RICHMOND PKWY STE 103
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-5718
Country	:	US
Telephone Number	:	510-686-4276
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TIMEA M MAJOROS
Credential	:
Telephone Number	:	973-868-9864

Provider Enumeration Date	:	09/13/2020
Last Update Date	:	09/13/2020

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Directions to “MYRO ENTERPRISES CORPORATION ” Practice Location

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