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General NPI Number Information
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NPI Number | 1902331622
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Entity Type | Organization
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Legal Business Name | MISSION TOXICOLOGY, LLC
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Dates
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Enumeration Date | 05/01/2017
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Last Update Date | 05/01/2017
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Provider Practice Location Address
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Address Line | 23052 ALICIA PKWY STE H495
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City | MISSION VIEJO
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State | CA
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Zip | 92692-1643
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Country | US
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Telephone | 951-475-7784
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Fax | 951-384-2820
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Provider Business Mailing Address
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Address Line | PO BOX 894388
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City | LOS ANGELES
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State | CA
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Zip | 90189-4388
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Country | US
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Telephone | 951-475-7784
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Fax | 951-384-2820
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Authorized Official
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Title or Position | PRESIDENT
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Name | RON LAZATIN
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Credential |
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Telephone | 951-475-7784
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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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