Healthcare Provider Details

I. General information

NPI: 1366207664
Provider Name (Legal Business Name): CARTER LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 FAIRBANKS STE 114
IRVINE CA
92618-1688
US

IV. Provider business mailing address

30 FAIRBANKS STE 114
IRVINE CA
92618-1688
US

V. Phone/Fax

Practice location:
  • Phone: 949-988-2001
  • Fax: 949-988-2002
Mailing address:
  • Phone: 949-988-2001
  • Fax: 949-988-2002

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: ZIAD KALIOUNDJI
Title or Position: DIRECTOR
Credential:
Phone: 310-994-9903