Provider Demographics
NPI:1336217793
Name:JAVIER NORIEGA
Entity Type:Organization
Organization Name:JAVIER NORIEGA
Other - Org Name:FIRST BLOOB MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:NORIEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-649-8810
Mailing Address - Street 1:1380 E MEDICAL CENTER DR # 109
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2123
Mailing Address - Country:US
Mailing Address - Phone:801-649-8810
Mailing Address - Fax:801-516-1418
Practice Address - Street 1:1380 E MEDICAL CENTER DR # 109
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2123
Practice Address - Country:US
Practice Address - Phone:801-649-8810
Practice Address - Fax:801-516-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT291U00000X
IL291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory