1891116430 NPI number — FAMILY PHYSICIANS LABORATORIES,INC.

Table of content: (NPI 1891116430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891116430 NPI number — FAMILY PHYSICIANS LABORATORIES,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PHYSICIANS LABORATORIES,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:
1891116430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1163 E WOODHAVEN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93720-1414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-355-1602
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3121 E OLIVE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93702-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-355-1602
Provider Business Practice Location Address Fax Number:
559-277-2723
Provider Enumeration Date:
12/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ESNAOLA
Authorized Official First Name:
LOLITA
Authorized Official Middle Name:
IGNACIO
Authorized Official Title or Position:
CLS
Authorized Official Telephone Number:
559-355-1602

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  MTA35029 , 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)





Copyright © 2007-2025 www.npivalidator.com