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General NPI Number Information
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NPI Number | 1134405012
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Entity Type | Organization
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Legal Business Name | EPINEX DIAGNOSTICS LABORATORIES, INC.
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 14351 MYFORD RD SUITE K
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City | TUSTIN
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State | CA
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Zip | 92780-7074
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Country | US
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Telephone | 949-464-5682
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Fax | 714-731-1229
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Provider Business Mailing Address
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Address Line | 14351 MYFORD RD SUITE K
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City | TUSTIN
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State | CA
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Zip | 92780-7074
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Country | US
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Telephone | 949-464-5682
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Fax | 714-731-7229
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Authorized Official
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Title or Position | C.E.O.
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Name | SRI BHARAT MADIREDDY
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Credential | PH.D.
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Telephone | 561-249-4317
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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 | CLF00340713
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License Number State | CA
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