Organization
ADVANTA LABS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YUSUF M HADIAN (AUTHORIZED OFFICIAL)
(817) 488-8000
Entity
Organization
Contact information
Practice address
535 S NOLEN DR STE 100, SOUTHLAKE, TX 76092-9194
(817) 488-8000
(817) 488-8001
Mailing address
535 S NOLEN DR STE 100, SOUTHLAKE, TX 76092-9194
(817) 488-8000
(817) 488-8001
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3715898-02
—
TX
01
—
45D2072790
CLIA NUMBER
TX
Enumeration date
03/14/2014
Last updated
05/15/2021
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