Healthcare Provider Details

I. General information

NPI: 1891116430
Provider Name (Legal Business Name): FAMILY PHYSICIANS LABORATORIES,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2013
Last Update Date: 03/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 E OLIVE AVE
FRESNO CA
93702-1030
US

IV. Provider business mailing address

1163 E WOODHAVEN LN
FRESNO CA
93720-1414
US

V. Phone/Fax

Practice location:
  • Phone: 559-355-1602
  • Fax: 559-277-2723
Mailing address:
  • Phone: 559-355-1602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberMTA35029
License Number StateCA

VIII. Authorized Official

Name: MRS. LOLITA IGNACIO ESNAOLA
Title or Position: CLS
Credential: CLS
Phone: 559-355-1602