Provider Demographics
NPI:1104289438
Name:PRESIDIO LABORATORIES CORP
Entity type:Organization
Organization Name:PRESIDIO LABORATORIES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:B
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-526-7880
Mailing Address - Street 1:3215 GATEWAY BLVD W
Mailing Address - Street 2:SUITE C
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-4225
Mailing Address - Country:US
Mailing Address - Phone:915-526-7880
Mailing Address - Fax:
Practice Address - Street 1:3215 GATEWAY BLVD W
Practice Address - Street 2:SUITE C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4225
Practice Address - Country:US
Practice Address - Phone:915-526-7880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EL PASO PAIN CENTER, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory