Healthcare Provider Details

I. General information

NPI: 1306104864
Provider Name (Legal Business Name): AMERICAN INDUSTRIAL LABORATORIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2012
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21163 NEWPORT COAST DR STE 500
NEWPORT COAST CA
92657-1123
US

IV. Provider business mailing address

PO BOX 13302
NEWPORT BEACH CA
92658-5092
US

V. Phone/Fax

Practice location:
  • Phone: 949-829-1170
  • Fax:
Mailing address:
  • Phone: 949-829-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: FRANK HAMADANI
Title or Position: COO
Credential:
Phone: 949-829-1170