Provider Demographics
NPI:1952030298
Name:WELLNESSPOINT LABS LLC
Entity Type:Organization
Organization Name:WELLNESSPOINT LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SUPERVISOR/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:SHUAYB
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-277-9700
Mailing Address - Street 1:17105 114TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5930
Mailing Address - Country:US
Mailing Address - Phone:623-277-9700
Mailing Address - Fax:
Practice Address - Street 1:15203 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:SEATAC
Practice Address - State:WA
Practice Address - Zip Code:98188-2141
Practice Address - Country:US
Practice Address - Phone:206-310-9163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory