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General NPI Number Information
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NPI Number | 1124524558
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Entity Type | Organization
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Legal Business Name | LIVINGSTON MED LAB LLC
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 18322 SONTERRA PL STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4196
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Country | US
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Telephone | 210-881-9072
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Fax |
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Provider Business Mailing Address
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Address Line | 18322 SONTERRA PL STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4196
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Country | US
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Telephone | 210-881-9072
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Fax | 210-881-9085
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Authorized Official
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Title or Position | OWNER
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Name | CARLOS ROBERTO CASTANEDA
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Credential |
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Telephone | 210-265-9414
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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 |
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License Number State |
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