Healthcare Provider Details

I. General information

NPI: 1366760522
Provider Name (Legal Business Name): AMBS DIAGNOSTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 S LAKE AVE # 104
PASADENA CA
91101-2673
US

IV. Provider business mailing address

141 S LAKE AVE # 104
PASADENA CA
91101-2673
US

V. Phone/Fax

Practice location:
  • Phone: 626-792-4700
  • Fax:
Mailing address:
  • Phone: 626-792-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MR. ED J PANCONI
Title or Position: PRESIDENT & COO
Credential:
Phone: 626-792-4700