Provider Demographics
NPI:1053080028
Name:ULTRALAB
Entity Type:Organization
Organization Name:ULTRALAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB DIRECTOR MS(MLS)
Authorized Official - Prefix:
Authorized Official - First Name:ABDULMAJED
Authorized Official - Middle Name:
Authorized Official - Last Name:HAJJARABY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-513-1689
Mailing Address - Street 1:350 WESTPARK WAY # 101A
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3964
Mailing Address - Country:US
Mailing Address - Phone:817-513-1689
Mailing Address - Fax:
Practice Address - Street 1:350 WESTPARK WAY # 101A
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3964
Practice Address - Country:US
Practice Address - Phone:817-513-1689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory