OrganizationActive
Grand Canyon Lab LLC
NPI 1134814874 · Clinical Medical Laboratory · Phoenix, AZ
Provider details
- NPI number
- 1134814874
- Entity type
- Organization
- Primary specialty
- Clinical Medical LaboratoryLaboratories
- Organization subpart
- No
- Authorized official
- Theo Rukundo, Managing Director(857) 247-8763
Specialties & taxonomies
Laboratories
Profile Score
Established profile(58/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4141 N 32nd St Ste 102
Phoenix, AZ 85018-4775
Phone: (857) 247-8763
Street-level locationGet directions
Mailing address
4141 N 32nd St Ste 102
Phoenix, AZ 85018-4775
Registry dates
- Enumerated
- 2023-04-10
- Last updated
- 2023-04-10
- Certified
- 2023-04-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.