East Valley Diagnostics LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EAST VALLEY DIAGNOSTICS LLC

Practice address

2509 S Power Rd Ste 105
Mesa, AZ 85209-6696

Phone

(623) 624-7420

Fax

(623) 624-7409

NPI assigned

May 2, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jake Gabbard

Title

Ceo

Phone

(623) 624-7420

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762128000000",
    "number": "1104615673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2509 S POWER RD STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852096696",
            "telephone_number": "623-624-7420",
            "fax_number": "623-624-7409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2509 S POWER RD STE 105",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852096696",
            "telephone_number": "623-624-7420",
            "fax_number": "623-624-7409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST VALLEY DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-02",
        "last_updated": "2025-11-03",
        "certification_date": "2025-11-03",
        "status": "A",
        "authorized_official_last_name": "GABBARD",
        "authorized_official_first_name": "JAKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "623-624-7420",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• East Valley Dental Professionals
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• Clinical Medical Laboratory in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Clinical Medical Laboratory in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.