Provider Demographics
NPI:1750026472
Name:VISITING HEARTS LABS
Entity Type:Organization
Organization Name:VISITING HEARTS LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-927-8751
Mailing Address - Street 1:738 E FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-2714
Mailing Address - Country:US
Mailing Address - Phone:310-927-8751
Mailing Address - Fax:
Practice Address - Street 1:11225 N 28TH DRIVE
Practice Address - Street 2:SUITE 102-12
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-2045
Practice Address - Country:US
Practice Address - Phone:480-770-6192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory