Provider Demographics
NPI:1942922216
Name:FAITHFUL MOBILE LABS LLC
Entity Type:Organization
Organization Name:FAITHFUL MOBILE LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:JOVONNE
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-624-6035
Mailing Address - Street 1:1818 N DECATUR BLVD UNIT 104
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-2257
Mailing Address - Country:US
Mailing Address - Phone:702-624-6035
Mailing Address - Fax:
Practice Address - Street 1:1818 N DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2395
Practice Address - Country:US
Practice Address - Phone:702-624-6035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory