Healthcare Provider Details

I. General information

NPI: 1619700895
Provider Name (Legal Business Name): NORTH VALLEY LABORATORY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LINCOLIN RD STE H PMB 813
SACRAMENTO CA
95953
US

IV. Provider business mailing address

1000 LINCOLIN RD STE H PMB 813
SACRAMENTO CA
95953
US

V. Phone/Fax

Practice location:
  • Phone: 530-649-7945
  • Fax:
Mailing address:
  • Phone: 530-649-7945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: HELDAI AGUILAR
Title or Position: OWNER
Credential: CPT1
Phone: 530-649-7945