=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245643758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTOX LABS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2014
-----------------------------------------------------
Last Update Date | 05/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18102 SKY PARK SOUTH BLDG 52, SUITE E
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92614-6531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-371-2050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18102 SKY PARK SOUTH BLDG 52, SUITE E
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92614-6531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-371-2050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. STEPHEN LUNDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 949-371-2050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------