1467030536 NPI number — WORKSITE LABS, INC.

Table of content: (NPI 1467030536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467030536 NPI number — WORKSITE LABS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORKSITE LABS, INC.
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:
1467030536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 PINE AVE STE 370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90802-4718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-599-9150
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1890 E MIRALOMA AVE STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLACENTIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92870-6746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-747-1122
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2021

Additional Information

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
GARY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
661-599-9150

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CLF-90002704 . This is a "CALIFORNIA DEPARTMENT OF PUBLIC HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 05D2196230 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 05D2210010 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50D2201374 . This is a "WASHINGTON STATE DEPARTMENT OF HEALTH CLIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CLF-90001796 . This is a "CALIFORNIA DEPARTMENT OF PUBLIC HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CLF-90002641 . This is a "CALIFORNIA DEPARTMENT OF PUBLIC HEALTH" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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