Healthcare Provider Details

I. General information

NPI: 1033137088
Provider Name (Legal Business Name): UNILAB CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 S BATAVIA ST STE 102
ORANGE CA
92868-3937
US

IV. Provider business mailing address

1201 S COLLEGEVILLE RD
COLLEGEVILLE PA
19426-2998
US

V. Phone/Fax

Practice location:
  • Phone: 714-997-9826
  • Fax:
Mailing address:
  • Phone: 866-697-8378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0643397
License Number StateCA

VIII. Authorized Official

Name: CHARLES ALBERT BOWLES
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-454-6000