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General NPI Number Information
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NPI Number | 1629437033
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Entity Type | Organization
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Legal Business Name | DNA REFERENCE LAB
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 5819 NW LOOP 410 STE 166
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City | SAN ANTONIO
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State | TX
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Zip | 78238-2500
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Country | US
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Telephone | 210-692-3800
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Fax | 210-615-0100
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Provider Business Mailing Address
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Address Line | 5819 NW LOOP 410 STE 166
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City | SAN ANTONIO
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State | TX
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Zip | 78238-2500
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Country | US
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Telephone | 210-692-3800
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Fax | 210-615-0100
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Authorized Official
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Title or Position | MEDICAL LABORATORY DIRECTOR & FTL
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Name | DR. ALI MOHAMMED SALIH
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Credential | BVSC, MT (ASCP), MS,
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Telephone | 210-692-3800
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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 | 45D0938564
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License Number State | TX
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