Healthcare Provider Details

I. General information

NPI: 1629131511
Provider Name (Legal Business Name): HOME LAB SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 POST ST
SAN FRANCISCO CA
94115-3427
US

IV. Provider business mailing address

1554 19TH AVE
SAN FRANCISCO CA
94122-3417
US

V. Phone/Fax

Practice location:
  • Phone: 415-299-2225
  • Fax: 415-931-0905
Mailing address:
  • Phone: 141-529-9222
  • Fax: 415-931-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name: VLADYSLAV BEZRUCHKO
Title or Position: OWNER
Credential:
Phone: 14152992225