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General NPI Number Information
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NPI Number | 1255657219
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Entity Type | Organization
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Legal Business Name | ADVANCE MEDICAL LAB
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 2016 E GRIFFIN PKWY
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City | MISSION
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State | TX
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Zip | 78572-3223
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Country | US
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Telephone | 956-581-5555
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Fax | 956-581-5573
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Provider Business Mailing Address
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Address Line | 2016 E GRIFFIN PKWY
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City | MISSION
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State | TX
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Zip | 78572-3223
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Country | US
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Telephone | 956-581-5555
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Fax | 956-581-5573
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Authorized Official
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Title or Position | LAB TECH
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Name | MR. RICARDO DELGADO
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Credential |
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Telephone | 956-581-5555
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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 | TX
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