Provider Demographics
NPI:1821824442
Name:EVIA DIAGNOSTICS MARIN LLC
Entity type:Organization
Organization Name:EVIA DIAGNOSTICS MARIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-475-4620
Mailing Address - Street 1:446 OLD COUNTY RD STE 100-340
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3270
Mailing Address - Country:US
Mailing Address - Phone:415-475-4620
Mailing Address - Fax:
Practice Address - Street 1:4340 REDWOOD HWY STE A33
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2121
Practice Address - Country:US
Practice Address - Phone:415-475-4620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory