Healthcare Provider Details

I. General information

NPI: 1336368596
Provider Name (Legal Business Name): HWY CLINICAL LABORATORY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 W LA VETA AVE
ORANGE CA
92868-3930
US

IV. Provider business mailing address

21115 DEVONSHIRE ST SUITE 381
CHATSWORTH CA
91311-2317
US

V. Phone/Fax

Practice location:
  • Phone: 818-300-2334
  • Fax:
Mailing address:
  • Phone: 818-300-2334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number05D0883369
License Number StateCA

VIII. Authorized Official

Name: DAVID A PARTRICK
Title or Position: PRESIDENT
Credential:
Phone: 818-300-2334