Provider Demographics
NPI:1912529157
Name:EIV DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:EIV DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BABAR
Authorized Official - Middle Name:KHAN
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-764-3505
Mailing Address - Street 1:1477 E SHAW AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-8021
Mailing Address - Country:US
Mailing Address - Phone:559-777-7117
Mailing Address - Fax:866-405-5984
Practice Address - Street 1:1477 E SHAW AVE STE 170
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8021
Practice Address - Country:US
Practice Address - Phone:559-777-7117
Practice Address - Fax:866-405-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-11
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory