Provider Demographics
NPI:1043577240
Name:PRECISION DIAGNOSTIC LABORATORIES LLC
Entity Type:Organization
Organization Name:PRECISION DIAGNOSTIC LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:KOZMARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-324-8714
Mailing Address - Street 1:2851 EL CAMINO AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-4266
Mailing Address - Country:US
Mailing Address - Phone:702-324-8714
Mailing Address - Fax:
Practice Address - Street 1:2851 EL CAMINO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4266
Practice Address - Country:US
Practice Address - Phone:702-324-8714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory