Provider Demographics
NPI:1497145502
Name:LUCENTA LABORATORY LLC
Entity Type:Organization
Organization Name:LUCENTA LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNDRU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:972-294-5076
Mailing Address - Street 1:7589 PRESTON RD
Mailing Address - Street 2:SUITE 900
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5667
Mailing Address - Country:US
Mailing Address - Phone:972-294-5076
Mailing Address - Fax:972-294-5235
Practice Address - Street 1:7589 PRESTON RD
Practice Address - Street 2:SUITE 900
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5667
Practice Address - Country:US
Practice Address - Phone:972-294-5076
Practice Address - Fax:972-294-5235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2081612291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM9927OtherTEXAS MEDICAL BOARD LICENSE