Provider Demographics
NPI:1265829279
Name:ALAMEDA LABORATORY SERVICES, LLC
Entity Type:Organization
Organization Name:ALAMEDA LABORATORY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:915-849-7759
Mailing Address - Street 1:4900 ALAMEDA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2832
Mailing Address - Country:US
Mailing Address - Phone:915-270-9998
Mailing Address - Fax:915-270-9997
Practice Address - Street 1:4900 ALAMEDA AVE STE E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2832
Practice Address - Country:US
Practice Address - Phone:915-270-9998
Practice Address - Fax:915-270-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32056766846291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX349500401Medicaid
TX426169OtherMEDICARE