Provider Demographics
NPI:1083802730
Name:ELI-LEO LLC
Entity Type:Organization
Organization Name:ELI-LEO LLC
Other - Org Name:LAREDO DIAGNOSTIC LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-236-9028
Mailing Address - Street 1:6262 MCPHERSON RD
Mailing Address - Street 2:STE# 107
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6171
Mailing Address - Country:US
Mailing Address - Phone:956-717-2821
Mailing Address - Fax:956-717-0630
Practice Address - Street 1:6262 MCPHERSON RD
Practice Address - Street 2:STE# 107
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6171
Practice Address - Country:US
Practice Address - Phone:956-717-2821
Practice Address - Fax:956-717-0630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory