Provider Demographics
NPI:1518794122
Name:PRUDENT LABORATORIES
Entity type:Organization
Organization Name:PRUDENT LABORATORIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-949-1355
Mailing Address - Street 1:5700 TENNYSON PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3595
Mailing Address - Country:US
Mailing Address - Phone:414-949-1355
Mailing Address - Fax:
Practice Address - Street 1:5700 TENNYSON PKWY STE 300
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3595
Practice Address - Country:US
Practice Address - Phone:414-949-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-17
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service