Provider Demographics
NPI:1942575386
Name:CITILAB LLC
Entity Type:Organization
Organization Name:CITILAB LLC
Other - Org Name:CITILAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-858-0360
Mailing Address - Street 1:2440 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE # 130
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2648
Mailing Address - Country:US
Mailing Address - Phone:702-898-0245
Mailing Address - Fax:702-898-0245
Practice Address - Street 1:2440 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE # 130
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2648
Practice Address - Country:US
Practice Address - Phone:702-898-0245
Practice Address - Fax:702-898-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory