Provider Demographics
NPI:1093696395
Name:MDX LABORATORY
Entity type:Organization
Organization Name:MDX LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODOLFO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-503-8457
Mailing Address - Street 1:5251 W CAMPBELL AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85031-1719
Mailing Address - Country:US
Mailing Address - Phone:602-503-8457
Mailing Address - Fax:602-218-7484
Practice Address - Street 1:5251 W CAMPBELL AVE STE 205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1719
Practice Address - Country:US
Practice Address - Phone:602-503-8457
Practice Address - Fax:602-218-7484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service