GRAND CANYON LAB LLC
NPI 1134814874
Clinical Medical Laboratory in Phoenix, AZ

Active since April 10, 2023
4141 N 32ND ST STE 102, PHOENIX, AZ 85018(857) 247-8763 Get Directions Write a Review

NPPES record last updated: April 10, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Grand Canyon Lab Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GRAND CANYON LAB LLC (NPI 1134814874) is a healthcare organization registered as a clinical medical laboratory in Phoenix, Arizona and active in the NPI registry since April 2023. The organization lists Theo Blaise Rukundo, Managing Director, as its authorized official.

NPPES Registry Identity

NPI1134814874
Entity TypeOrganization
Primary Taxonomy291U00000X
Legal Business NameGRAND CANYON LAB LLC
Location Address4141 N 32ND ST STE 102Phoenix, AZ 85018-4775
Mailing Address4141 N 32nd St Ste 102Phoenix, AZ 85018-4775 · (857) 247-8763
Organization SubpartNo
Authorized OfficialTheo Blaise RukundoManaging Director · (857) 247-8763
Enumeration DateApril 10, 2023
NPPES CertifiedApril 8, 2023
NPI 1134814874 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinical Medical LaboratoryLaboratories
Taxonomy Code291U00000X
Definition

(1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.

4141 N 32ND ST STE 102, Phoenix, AZ 85018

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Grand Canyon Lab LLC's NPI number?

The NPI number for Grand Canyon Lab LLC is 1134814874. It was assigned to this organization in the NPPES registry on April 10, 2023.

Where is Grand Canyon Lab LLC located?

Grand Canyon Lab LLC is located at 4141 N 32nd St Ste 102, Phoenix, AZ 85018. The listed phone number is (857) 247-8763.

What is Grand Canyon Lab LLC's specialty?

The primary specialty registered for this NPI is Clinical Medical Laboratory with taxonomy code 291U00000X.

When was this NPI record last updated?

The NPPES record for Grand Canyon Lab LLC was last updated on April 10, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.