Provider Demographics
NPI:1336957448
Name:E-LAB OF LAS VEGAS, LLC
Entity type:Organization
Organization Name:E-LAB OF LAS VEGAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONIDAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:FLANGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-217-1026
Mailing Address - Street 1:616 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-7005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2950 S RAINBOW BLVD STE 260
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6213
Practice Address - Country:US
Practice Address - Phone:725-214-4367
Practice Address - Fax:725-214-4469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory