Provider Demographics
NPI:1821845934
Name:IMVARIA LABS LLC
Entity type:Organization
Organization Name:IMVARIA LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUELLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-683-9809
Mailing Address - Street 1:2930 DOMINGO AVE # 1025
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2454
Mailing Address - Country:US
Mailing Address - Phone:650-683-9800
Mailing Address - Fax:
Practice Address - Street 1:1515 CRESCENT DR STE 100
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-3628
Practice Address - Country:US
Practice Address - Phone:650-683-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory