Organization
VITAL LAB, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAQUANDA CALDWELL (LABORATORY DIRECTOR)
(757) 971-1460
Entity
Organization
Contact information
Practice address
355 CRAWFORD ST STE 512, PORTSMOUTH, VA 23704-2816
(757) 971-1460
(757) 594-1460
Mailing address
355 CRAWFORD ST STE 512, PORTSMOUTH, VA 23704-2816
(757) 971-1460
(757) 594-1460
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QI0500X
Infusion Therapy Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49D2199943
CLIA
VA
Enumeration date
11/03/2020
Last updated
04/06/2026
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