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General NPI Number Information
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NPI Number | 1225632029
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Entity Type | Organization
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Legal Business Name | ONSITE LABORATORIES, LLC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 2040 E MARIPOSA AVE
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City | EL SEGUNDO
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State | CA
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Zip | 90245-5027
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Country | US
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Telephone | 866-522-5467
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Fax | 866-522-5467
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Provider Business Mailing Address
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Address Line | 601 MAIN AVE W
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City | WEST FARGO
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State | ND
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Zip | 58078-1549
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Country | US
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Telephone | 866-522-5467
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Fax | 866-522-5467
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Authorized Official
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Title or Position | OWNER AND CEO
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Name | ABIGAIL DERHEIM
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Credential |
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Telephone | 866-522-5467
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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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