Healthcare Provider Details

I. General information

NPI: 1376470518
Provider Name (Legal Business Name): MID VALLEY 626 LABORATORIES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 W DUARTE RD STE 150
ARCADIA CA
91007-7600
US

IV. Provider business mailing address

630 W DUARTE RD STE 150
ARCADIA CA
91007-7600
US

V. Phone/Fax

Practice location:
  • Phone: 626-215-4186
  • Fax:
Mailing address:
  • Phone: 626-215-4186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MARK GOLDMAN
Title or Position: OWNER PRESIDENT
Credential:
Phone: 626-215-4186