Healthcare Provider Details

I. General information

NPI: 1508600503
Provider Name (Legal Business Name): MR. BYRON MCNAIR JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 S SYCAMORE AVE
LOS ANGELES CA
90019-5340
US

IV. Provider business mailing address

3400 COTTAGE WAY
SACRAMENTO CA
95825-1474
US

V. Phone/Fax

Practice location:
  • Phone: 951-502-4165
  • Fax:
Mailing address:
  • Phone: 800-614-5996
  • Fax: 877-940-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT-02389671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: