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General NPI Number Information
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NPI Number | 1700913118
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Entity Type | Organization
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Legal Business Name | BIOLOGICAL LABORATORY, INC.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 620 W. COVINA BLVD
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City | SAN DIMAS
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State | CA
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Zip | 91773-2956
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Country | US
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Telephone | 909-718-4592
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Fax | 909-469-6718
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Provider Business Mailing Address
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Address Line | 620 W. COVINA BLVD
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City | SAN DIMAS
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State | CA
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Zip | 91773-2956
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Country | US
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Telephone | 909-718-4592
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Fax | 909-469-6718
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Authorized Official
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Title or Position | CEO
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Name | EUFEMIA DAVID
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Credential | BSMT
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Telephone | 909-718-4592
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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 | CLF11375
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License Number State | CA
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