Provider Demographics
NPI:1912666595
Name:CENTRAL VALLEY TESTING CENTER LLC
Entity Type:Organization
Organization Name:CENTRAL VALLEY TESTING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAMAU
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-232-8177
Mailing Address - Street 1:8925 N 43RD AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-3616
Mailing Address - Country:US
Mailing Address - Phone:602-974-0074
Mailing Address - Fax:
Practice Address - Street 1:8925 N 43RD AVE STE 5
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-3616
Practice Address - Country:US
Practice Address - Phone:602-974-0074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory