Provider Demographics
NPI:1275161671
Name:SOFT CELL L-FORM LABORATORIES LLC
Entity Type:Organization
Organization Name:SOFT CELL L-FORM LABORATORIES LLC
Other - Org Name:SOFT CELL LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-628-2215
Mailing Address - Street 1:453 S 600 E RM 154
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3733
Mailing Address - Country:US
Mailing Address - Phone:435-628-2215
Mailing Address - Fax:435-359-5184
Practice Address - Street 1:453 S 600 E RM 154
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3733
Practice Address - Country:US
Practice Address - Phone:435-628-2215
Practice Address - Fax:435-359-5184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-31
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory