Provider Demographics
NPI:1033267596
Name:CARDIOLAB, LLC
Entity Type:Organization
Organization Name:CARDIOLAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:956-207-7812
Mailing Address - Street 1:10331 N 24TH LN
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6286
Mailing Address - Country:US
Mailing Address - Phone:956-207-7812
Mailing Address - Fax:866-624-4990
Practice Address - Street 1:3241 N 38TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3301
Practice Address - Country:US
Practice Address - Phone:956-207-7812
Practice Address - Fax:866-624-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D1091769OtherCLIA
TXCL1054OtherMEDICARE GROUP PTAN