Healthcare Provider Details

I. General information

NPI: 1992161632
Provider Name (Legal Business Name): PACHULSKI INDUSTRIES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COPA DE ORO RD
LOS ANGELES CA
90077-3802
US

IV. Provider business mailing address

100 COPA DE ORO RD
LOS ANGELES CA
90077-3802
US

V. Phone/Fax

Practice location:
  • Phone: 573-207-5147
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN PACHULSKI
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 310-600-8359