Provider Demographics
NPI:1821381773
Name:ALETHEA LABORATORIES INC
Entity Type:Organization
Organization Name:ALETHEA LABORATORIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SRI
Authorized Official - Middle Name:BHARAT
Authorized Official - Last Name:MADIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:561-249-4317
Mailing Address - Street 1:410 E. FOSTER ROAD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3209
Mailing Address - Country:US
Mailing Address - Phone:575-267-6441
Mailing Address - Fax:575-267-2320
Practice Address - Street 1:410 E. FOSTER ROAD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3209
Practice Address - Country:US
Practice Address - Phone:575-267-6441
Practice Address - Fax:575-267-2320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-25
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM32D2021850291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL800027351OtherCLINICAL LABORATORY LICENSE
32D2021850OtherCLIA
COB5169OtherMEDICARE PTAN