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General NPI Number Information
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NPI Number | 1194478867
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Entity Type | Organization
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Legal Business Name | SECOND BIO LAB CLINICAL LABORATORY
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 316 E LAS TUNAS DR STE 206
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City | SAN GABRIEL
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State | CA
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Zip | 91776-1535
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Country | US
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Telephone | 626-300-8880
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Fax | 626-300-8811
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Provider Business Mailing Address
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Address Line | 316 E LAS TUNAS DR STE 206
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City | SAN GABRIEL
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State | CA
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Zip | 91776-1535
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Country | US
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Telephone | 626-300-8880
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Fax | 626-300-8811
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Authorized Official
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Title or Position | OWNER
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Name | GABRIELA ORUE-PEREA
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Credential |
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Telephone | 818-484-1315
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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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