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General NPI Number Information
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NPI Number | 1942228994
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Entity Type | Organization
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Legal Business Name | UNILAB CORPORATION
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 09/07/2023
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Provider Practice Location Address
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Address Line | 2065 SPERRY AVE
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City | VENTURA
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State | CA
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Zip | 93003-7451
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Country | US
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Telephone | 805-642-0236
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Fax | 805-642-3458
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Provider Business Mailing Address
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Address Line | 14275 MIDWAY RD STE 400
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City | ADDISON
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State | TX
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Zip | 75001-3614
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Country | US
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Telephone | 866-697-8378
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | CHARLES ALBERT BOWLES
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Credential |
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Telephone | 866-697-8378
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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 | 05D0583125
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License Number State | CA
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