Exevia Diagnostics LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

EXEVIA DIAGNOSTICS LLC

Practice address

771 E Southlake Blvd Ste 217
Southlake, TX 76092-6989

Phone

(469) 638-8875

NPI assigned

Aug 2, 2023

Reactivated

Nov 27, 2024

Organization subpart

No

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

Authorized official

Name

Ani Petrosyan

Title

Owner

Phone

(303) 228-6119

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1690934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773360000000",
    "number": "1285316075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 E SOUTHLAKE BLVD STE 217",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926989",
            "telephone_number": "303-228-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 E SOUTHLAKE BLVD STE 217",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926989",
            "telephone_number": "469-638-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXEVIA DIAGNOSTICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-02",
        "last_updated": "2026-03-13",
        "certification_date": "2026-03-13",
        "deactivation_date": "2024-11-20",
        "reactivation_date": "2024-11-27",
        "status": "A",
        "authorized_official_last_name": "PETROSYAN",
        "authorized_official_first_name": "ANI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-228-6119"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gena Marie Ettinger, PA-C
• Aaron C Eubanks, MD
• Eunoia Psychiatry Associates,PA
• Wyatt R Evans, PHD
• Exevia Diagnostics LLC
• Exevia Diagnostics LLC
• Exevia Diagnostics LLC
• Exevia Diagnostics LLC
• Eyes on Southlake PLLC
• Ezmed

• Clinical Medical Laboratory in Southlake, TX
• Providers in Southlake, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.