Provider Demographics
NPI:1013376151
Name:AZ LAB, LLC
Entity Type:Organization
Organization Name:AZ LAB, LLC
Other - Org Name:COREBELLA ALLERGY & DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONNA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:DEMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-242-0346
Mailing Address - Street 1:2210 S MILL AVE
Mailing Address - Street 2:8
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-2153
Mailing Address - Country:US
Mailing Address - Phone:623-242-0346
Mailing Address - Fax:
Practice Address - Street 1:2210 S MILL AVE
Practice Address - Street 2:8
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2153
Practice Address - Country:US
Practice Address - Phone:623-242-0346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4476207KA0200X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty