Provider Demographics
NPI:1104569730
Name:NEVA DIAGNOSTICS
Entity type:Organization
Organization Name:NEVA DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-886-7292
Mailing Address - Street 1:12200 FORD RD STE A102
Mailing Address - Street 2:
Mailing Address - City:FARMERS BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7244
Mailing Address - Country:US
Mailing Address - Phone:817-886-7292
Mailing Address - Fax:817-886-7291
Practice Address - Street 1:12200 FORD RD STE A102
Practice Address - Street 2:
Practice Address - City:FARMERS BRANCH
Practice Address - State:TX
Practice Address - Zip Code:75234-7244
Practice Address - Country:US
Practice Address - Phone:817-886-7292
Practice Address - Fax:817-886-7291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory