Provider Demographics
NPI:1801487830
Name:COLECTIVO LABORATORIES LLC
Entity type:Organization
Organization Name:COLECTIVO LABORATORIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-529-3859
Mailing Address - Street 1:10385 E DREYFUS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7287
Mailing Address - Country:US
Mailing Address - Phone:480-529-3859
Mailing Address - Fax:
Practice Address - Street 1:10385 E DREYFUS AVE
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7287
Practice Address - Country:US
Practice Address - Phone:480-529-3859
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical PathologyGroup - Multi-Specialty