Healthcare Provider Details

I. General information

NPI: 1861988982
Provider Name (Legal Business Name): BEST LAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIDALGO 248 A SAN ANTONIO TLAYACAPAN
CHAPALA JALISCO
45906
MX

IV. Provider business mailing address

HIDALGO 248 A SAN ANTONIO TLAYACAPAN
CHAPALA JALISCO
45906
MX

V. Phone/Fax

Practice location:
  • Phone: 888-449-7799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License NumberCP4876548
License Number StateZZ

VIII. Authorized Official

Name: MR. FRANCISCO SEPULVEDA
Title or Position: OWNER
Credential: CHEMIST
Phone: 888-449-7799