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General NPI Number Information
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NPI Number | 1487098562
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Entity Type | Organization
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Legal Business Name | US SPECIALTY LABS LP
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Dates
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Enumeration Date | 04/19/2013
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 15150 AVENUE OF SCIENCE SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92128
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Country | US
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Telephone | 858-209-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 15150 AVENUE OF SCIENCE SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92128
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Country | US
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Telephone | 858-209-2300
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. BRYAN ANDRUS
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Credential |
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Telephone | 858-837-1192
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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 | 05D2053446
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License Number State | CA
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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 |
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License Number State |
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