Provider Demographics
NPI:1790191633
Name:AMERICAN SPECIALTY LAB, L.L.C.
Entity Type:Organization
Organization Name:AMERICAN SPECIALTY LAB, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-233-1791
Mailing Address - Street 1:3176 AZURE BAY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2540
Mailing Address - Country:US
Mailing Address - Phone:702-233-1791
Mailing Address - Fax:702-233-1793
Practice Address - Street 1:7251 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1580
Practice Address - Country:US
Practice Address - Phone:702-233-1791
Practice Address - Fax:702-233-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory