{
"Npi": {
"NPI": "1700913118",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "BIOLOGICAL LABORATORY, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "620 W. COVINA BLVD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAN DIMAS",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "91773-2956",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "909-718-4592",
"MailingAddressFaxNumber": "909-469-6718",
"FirstLinePracticeLocationAddress": "620 W. COVINA BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAN DIMAS",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91773-2956",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "909-718-4592",
"PracticeLocationAddressFaxNumber": "909-469-6718",
"EnumerationDate": "02/27/2007",
"LastUpdateDate": "03/14/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DAVID",
"AuthorizedOfficialFirstName": "EUFEMIA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "BSMT",
"AuthorizedOfficialTelephoneNumber": "909-718-4592",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": "CLF11375",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}