Healthcare Provider Details

I. General information

NPI: 1023360039
Provider Name (Legal Business Name): MED-X DRUG & ALCOHOL TESTING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD SUITE 825
LOS ANGELES CA
90025-1708
US

IV. Provider business mailing address

11645 WILSHIRE BLVD SUITE 825
LOS ANGELES CA
90025-1708
US

V. Phone/Fax

Practice location:
  • Phone: 310-207-3320
  • Fax:
Mailing address:
  • Phone: 310-207-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number44883114
License Number StateCA

VIII. Authorized Official

Name: MR. NOEL FRANCIS LAURENTE
Title or Position: ADMINISTRATORS
Credential:
Phone: 310-207-3320