Provider Demographics
NPI:1760089080
Name:COV10 PLUS TESTING LABORATORY
Entity Type:Organization
Organization Name:COV10 PLUS TESTING LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:RUSTOM
Authorized Official - Middle Name:TESTING
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-703-4227
Mailing Address - Street 1:590 N ALMA SCHOOL RD STE 7
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4382
Mailing Address - Country:US
Mailing Address - Phone:480-781-8199
Mailing Address - Fax:
Practice Address - Street 1:590 N ALMA SCHOOL RD STE 7
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4382
Practice Address - Country:US
Practice Address - Phone:480-781-8199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory