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General NPI Number Information
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NPI Number | 1609106756
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Entity Type | Organization
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Legal Business Name | CLINICAL TESTING LABORATORIES, INC.
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 3655 RESEARCH DR MSC3ARP, BOX 30001
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City | LAS CRUCES
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State | NM
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Zip | 88003-1239
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Country | US
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Telephone | 575-646-3465
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Fax | 575-646-6060
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Provider Business Mailing Address
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Address Line | 3655 RESEARCH DR MSC3ARP, BOX 30001
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City | LAS CRUCES
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State | NM
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Zip | 88003-1239
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Country | US
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Telephone | 575-646-3465
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Fax | 575-646-6060
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Authorized Official
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Title or Position | QUALITY MANAGER
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Name | MR. STEFAN ALFRED LONG
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Credential | CORP AGENT OF RECORD
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Telephone | 575-646-3465
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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 | 32D1086620
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License Number State | NM
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