Provider Demographics
NPI:1689083719
Name:REVEAL DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:REVEAL DIAGNOSTICS, LLC
Other - Org Name:REVEAL DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-730-0970
Mailing Address - Street 1:490 POST ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1401
Mailing Address - Country:US
Mailing Address - Phone:888-973-8325
Mailing Address - Fax:888-808-6160
Practice Address - Street 1:25001 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2801
Practice Address - Country:US
Practice Address - Phone:415-837-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-02
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty