Provider Demographics
NPI:1891549242
Name:INNOVEXLAB
Entity Type:Organization
Organization Name:INNOVEXLAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRATIBHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:850-339-0927
Mailing Address - Street 1:5830 SW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8525
Mailing Address - Country:US
Mailing Address - Phone:850-339-0927
Mailing Address - Fax:
Practice Address - Street 1:1135 NW 23RD AVE STE L
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3449
Practice Address - Country:US
Practice Address - Phone:352-328-3066
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory