Provider Demographics
NPI:1922436310
Name:SENTINEL LABORATORY, LLC
Entity Type:Organization
Organization Name:SENTINEL LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-563-6400
Mailing Address - Street 1:9787 N 91ST ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5088
Mailing Address - Country:US
Mailing Address - Phone:480-563-6400
Mailing Address - Fax:480-563-8009
Practice Address - Street 1:9787 N 91ST ST
Practice Address - Street 2:STE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5088
Practice Address - Country:US
Practice Address - Phone:480-563-6400
Practice Address - Fax:480-563-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory