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General NPI Number Information
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NPI Number | 1245409457
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Entity Type | Organization
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Legal Business Name | ONE SOURCE TOXICOLOGY LABORATORY INC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 01/08/2009
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Provider Practice Location Address
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Address Line | 1209 GENOA RED BLUFF RD
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City | PASADENA
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State | TX
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Zip | 77504
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Country | US
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Telephone | 713-920-2559
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Fax | 281-998-8587
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Provider Business Mailing Address
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Address Line | 1209 GENOA RED BLUFF RD
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City | PASADENA
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State | TX
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Zip | 77504
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Country | US
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Telephone | 713-920-2559
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Fax | 281-998-8587
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Authorized Official
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Title or Position | CEO
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Name | MR. ROMEO F LAUREL
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Credential |
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Telephone | 281-920-2559
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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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Taxonomy #2
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 45D1014951
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License Number State | TX
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