Provider Demographics
NPI:1982093076
Name:SAN TAN MOBILE DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:SAN TAN MOBILE DIAGNOSTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-362-0979
Mailing Address - Street 1:1457 W SOUTHERN AVE
Mailing Address - Street 2:SUITE 24
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4813
Mailing Address - Country:US
Mailing Address - Phone:928-362-0979
Mailing Address - Fax:480-999-5641
Practice Address - Street 1:1457 W SOUTHERN AVE
Practice Address - Street 2:SUITE 24
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4813
Practice Address - Country:US
Practice Address - Phone:928-362-0979
Practice Address - Fax:480-999-5641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory