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General NPI Number Information
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NPI Number | 1538812862
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Entity Type | Organization
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Legal Business Name | LAB AVENUE
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Dates
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Enumeration Date | 01/27/2022
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 29970 TECHNOLOGY DR STE 117G
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City | MURRIETA
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State | CA
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Zip | 92563-2647
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Country | US
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Telephone | 951-498-6448
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 249
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City | MURRIETA
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State | CA
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Zip | 92564-0249
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Country | US
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Telephone | 951-498-6448
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Fax |
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Authorized Official
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Title or Position | PRES
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Name | MR. FARHAN QURESHI
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Credential |
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Telephone | 951-498-6448
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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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