Healthcare Provider Details

I. General information

NPI: 1912104761
Provider Name (Legal Business Name): RADIATA LABORATORIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BARRANCA PKWY SUITE 104
IRVINE CA
92604-8603
US

IV. Provider business mailing address

1810 FULLERTON AVE SUITE 102
CORONA CA
92881-3103
US

V. Phone/Fax

Practice location:
  • Phone: 949-726-0682
  • Fax: 949-653-1852
Mailing address:
  • Phone: 951-738-2229
  • Fax: 951-738-2222

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: DR. PAUL C MAGARELLI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 951-738-2229