1992942783 NPI number — HUNTINGTON BEACH CLINICAL LABORATORY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992942783 NPI number — HUNTINGTON BEACH CLINICAL LABORATORY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTINGTON BEACH CLINICAL LABORATORY
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:
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:
1992942783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8071 SLATER AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HUNTINGTON BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92647-6960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-841-7789
Provider Business Mailing Address Fax Number:
714-841-9966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8071 SLATER AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HUNTINGTON BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92647-6960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-841-7789
Provider Business Practice Location Address Fax Number:
714-841-9966
Provider Enumeration Date:
01/15/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RELATO
Authorized Official First Name:
LOTA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-841-7789

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  CLF 334485 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CLF 334485 . This is a "CLIA # 05D1080532" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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