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General NPI Number Information
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NPI Number | 1073972980
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Entity Type | Organization
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Legal Business Name | CLINTOX LABORATORIES INC.
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Dates
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Enumeration Date | 02/19/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 516 N LARCHMONT BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-1306
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Country | US
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Telephone | 888-321-2869
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Fax |
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Provider Business Mailing Address
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Address Line | 516 N LARCHMONT BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90004-1306
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Country | US
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Telephone | 888-321-2869
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. SHAWN EBRA
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Credential |
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Telephone | 888-321-2869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 05D2106322
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License Number State | CA
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