Healthcare Provider Details

I. General information

NPI: 1326231465
Provider Name (Legal Business Name): ROBERT S KOELEWYN LABORATORY DIRECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 CAMPUS DR
HANFORD CA
93230-4375
US

IV. Provider business mailing address

330 CAMPUS DR
HANFORD CA
93230-4375
US

V. Phone/Fax

Practice location:
  • Phone: 559-584-1401
  • Fax: 559-583-8178
Mailing address:
  • Phone: 559-584-1401
  • Fax: 559-583-8178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: