Provider Demographics
NPI:1851833768
Name:PHAROS DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:PHAROS DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGTHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-885-3795
Mailing Address - Street 1:3830 VALLEY CENTRE DR
Mailing Address - Street 2:STE 705 PMB514
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3307
Mailing Address - Country:US
Mailing Address - Phone:520-355-2500
Mailing Address - Fax:855-875-6727
Practice Address - Street 1:3814 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-5145
Practice Address - Country:US
Practice Address - Phone:520-355-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-08
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D2120595291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory