Organization · NPI-2

1 Source Labs And Medical Services LLC

Point of Service · Phoenix, AZ

NPI number1730708017
StatusActive
Last updated in NPPESApr 16, 2020

Details

NPI
1730708017
Entity type
Organization (NPI-2)
Legal business name
1 Source Labs And Medical Services LLC
Organization subpart
No
Enumeration date
Apr 16, 2020
Certification date
Apr 16, 2020
Last updated
Apr 16, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
305S00000X Point of Service––Yes

Practice location

2440 W Mission Ln Ste 5
Phoenix, AZ 85021-2824

Phone 623-261-1716 · Fax 623-321-1569

Mailing address

2440 W Mission Ln Ste 5
Phoenix, AZ 85021-2824

Phone 623-261-1716 · Fax 623-321-1569

Authorized official

Manuel Enrique Salgado
Ceo
6232611716

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