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General NPI Number Information
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NPI Number | 1760749469
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Entity Type | Organization
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Legal Business Name | ONE SOURCE LABORATORIES, INC
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 9663 SANTA MONICA BLVD SUITE 363
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4303
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Country | US
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Telephone | 310-598-7339
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Fax |
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Provider Business Mailing Address
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Address Line | 9663 SANTA MONICA BLVD SUITE 363
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4303
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Country | US
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Telephone | 310-598-7339
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER KING
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Credential |
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Telephone | 310-598-7339
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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 |
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License Number State |
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