Provider Demographics
NPI:1720702491
Name:THRIVELAB CO.
Entity Type:Organization
Organization Name:THRIVELAB CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-282-7260
Mailing Address - Street 1:2654 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE. B5, PMB 1132
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2858
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:949-569-1295
Practice Address - Street 1:2719 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3354
Practice Address - Country:US
Practice Address - Phone:737-377-1600
Practice Address - Fax:949-569-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty