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General NPI Number Information
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NPI Number | 1811194939
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Entity Type | Organization
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Legal Business Name | MPOL LABORATORY LLC
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 1888 W 6TH ST SUITE H
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City | CORONA
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State | CA
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Zip | 92882-2993
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Country | US
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Telephone | 951-735-9190
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Fax | 951-340-2846
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Provider Business Mailing Address
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Address Line | 1888 W 6TH ST SUITE H
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City | CORONA
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State | CA
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Zip | 92882-2993
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Country | US
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Telephone | 951-735-9190
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Fax | 951-340-2846
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Authorized Official
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Title or Position | OWNER
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Name | DR. AHSAN BASEER
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Credential | PH.D.
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Telephone | 951-735-9190
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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 | CLF4840
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License Number State | CA
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