Organization
AMERICAN ESOTERIC LABORATORIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRYAN JONES (DIRECTOR OF ACCOUNTS RECEIVABLE)
(972) 910-9119
Entity
Organization
Contact information
Practice address
6221 RIVERSIDE DR, SUITE 119, IRVING, TX 75039-3528
(972) 910-9119
(214) 239-2650
Mailing address
6221 RIVERSIDE DR, SUITE 119, IRVING, TX 75039-3528
(972) 910-9119
(214) 239-2650
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1754954
—
TX
Enumeration date
09/26/2006
Last updated
08/22/2020
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