1003244880 NPI number — BANDAR ENTERPRISES LLC SERIES 1 ASSURITY LABS

Table of content: (NPI 1003244880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003244880 NPI number — BANDAR ENTERPRISES LLC SERIES 1 ASSURITY LABS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BANDAR ENTERPRISES LLC SERIES 1 ASSURITY LABS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003244880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8876 SPANISH RIDGE AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89148-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-749-5588
Provider Business Mailing Address Fax Number:
702-852-0396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6140 S FORT APACHE ROAD
Provider Second Line Business Practice Location Address:
SUITE #140
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-749-5588
Provider Business Practice Location Address Fax Number:
702-852-0396
Provider Enumeration Date:
10/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
STOJANOFF
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSED LAB DIRECTOR
Authorized Official Telephone Number:
702-749-5588

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  32514DIR-0 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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