Healthcare Provider Details

I. General information

NPI: 1124981220
Provider Name (Legal Business Name): MEDSTAR LAB SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 BONITA AVE
FOWLER CA
93625-2008
US

IV. Provider business mailing address

97 BONITA AVE
FOWLER CA
93625-2008
US

V. Phone/Fax

Practice location:
  • Phone: 651-318-2025
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QL0901X
TaxonomyDiplomate Laboratory Management Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MR. VALENTIN FLORES
Title or Position: PRESIDENT
Credential:
Phone: 165-131-8202