Provider Demographics
NPI:1679235782
Name:AVEM DIAGNOSTICS L.L.C.
Entity Type:Organization
Organization Name:AVEM DIAGNOSTICS L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF SCIENTIFIC OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT, CBT, CWS,
Authorized Official - Phone:338-957-0079
Mailing Address - Street 1:5670 WYNN RD STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2355
Mailing Address - Country:US
Mailing Address - Phone:833-693-2898
Mailing Address - Fax:
Practice Address - Street 1:5670 WYNN RD STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2355
Practice Address - Country:US
Practice Address - Phone:833-693-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical MicrobiologyGroup - Multi-Specialty
No207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty