Organization
CRESTAR LABS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FADEL ALSHALABI (CEO)
(704) 433-8888
Entity
Organization
Contact information
Practice address
1651 N COLLINS BLVD STE 130, RICHARDSON, TX 75080-3658
(469) 530-9050
(469) 530-9051
Mailing address
1651 N COLLINS BLVD STE 130, RICHARDSON, TX 75080-3658
(469) 530-9050
(469) 530-9051
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D2098649
TX
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3672776-01
—
TX
Enumeration date
08/25/2015
Last updated
06/11/2019
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