Provider Demographics
NPI:1619042314
Name:PORTABLE PULMONARY DIAGNOSTICS
Entity Type:Organization
Organization Name:PORTABLE PULMONARY DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-298-3355
Mailing Address - Street 1:3333 PARTRIDGE RUN ST
Mailing Address - Street 2:
Mailing Address - City:LAUGHLIN
Mailing Address - State:NV
Mailing Address - Zip Code:89029-0266
Mailing Address - Country:US
Mailing Address - Phone:702-298-3355
Mailing Address - Fax:
Practice Address - Street 1:3333 PARTRIDGE RUN ST
Practice Address - Street 2:
Practice Address - City:LAUGHLIN
Practice Address - State:NV
Practice Address - Zip Code:89029-0266
Practice Address - Country:US
Practice Address - Phone:702-298-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory