Provider Demographics
NPI:1629254644
Name:DESERT CRYOBANK INC
Entity Type:Organization
Organization Name:DESERT CRYOBANK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUJATHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNNALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-956-7481
Mailing Address - Street 1:3125 N 32ND ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6281
Mailing Address - Country:US
Mailing Address - Phone:602-956-7481
Mailing Address - Fax:602-956-7591
Practice Address - Street 1:3125 N 32ND ST
Practice Address - Street 2:SUITE 250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6281
Practice Address - Country:US
Practice Address - Phone:602-956-7481
Practice Address - Fax:602-956-7591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11933261QA0006X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QA0006XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Fertility Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
D44004Medicare UPIN