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General NPI Number Information
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NPI Number | 1679546907
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Entity Type | Organization
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Legal Business Name | LABORATORY PRACTICE, INC.
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10301 BOLSA AVE SUITE 204
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City | WESTMINSTER
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State | CA
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Zip | 92683-6784
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Country | US
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Telephone | 714-775-9000
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Fax | 714-531-1861
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Provider Business Mailing Address
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Address Line | 10301 BOLSA AVE SUITE 204
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City | WESTMINSTER
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State | CA
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Zip | 92683-6784
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Country | US
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Telephone | 714-775-9000
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Fax | 714-531-1861
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. PARVIZ BAHADORI
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Credential | PHD
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Telephone | 714-775-9000
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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 | LAB58511F
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License Number State | CA
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