Provider Demographics
NPI:1639791007
Name:CCL LABS LLC
Entity Type:Organization
Organization Name:CCL LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AYAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:844-990-1335
Mailing Address - Street 1:3720 E LA SALLE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3976
Mailing Address - Country:US
Mailing Address - Phone:844-990-1335
Mailing Address - Fax:855-631-0414
Practice Address - Street 1:2700 TIBBETS DR STE 102
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6900
Practice Address - Country:US
Practice Address - Phone:844-990-1335
Practice Address - Fax:855-631-0414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory