Provider Demographics
NPI:1740333822
Name:ADVANCED REPRODUCTIVE LABORATORY
Entity type:Organization
Organization Name:ADVANCED REPRODUCTIVE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SY
Authorized Official - Middle Name:Q
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-506-9986
Mailing Address - Street 1:7501 LAS COLINAS BLVD
Mailing Address - Street 2:200B
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-7518
Mailing Address - Country:US
Mailing Address - Phone:972-506-9986
Mailing Address - Fax:972-506-0044
Practice Address - Street 1:7501 LAS COLINAS BLVD
Practice Address - Street 2:200B
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-7518
Practice Address - Country:US
Practice Address - Phone:972-506-9986
Practice Address - Fax:972-506-0044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED REPRODUCTIVE MANAGEMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-19
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D093390291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory