Provider Demographics
NPI:1003244880
Name:BANDAR ENTERPRISES LLC SERIES 1 ASSURITY LABS
Entity Type:Organization
Organization Name:BANDAR ENTERPRISES LLC SERIES 1 ASSURITY LABS
Other - Org Name:ASSURITY LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED LAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOJANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-749-5588
Mailing Address - Street 1:8876 SPANISH RIDGE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1502
Mailing Address - Country:US
Mailing Address - Phone:702-749-5588
Mailing Address - Fax:702-852-0396
Practice Address - Street 1:6140 S FORT APACHE ROAD
Practice Address - Street 2:SUITE #140
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-749-5588
Practice Address - Fax:702-852-0396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32514DIR-0291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory