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General NPI Number Information
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NPI Number | 1962642249
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Entity Type | Organization
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Legal Business Name | WESCA LABORATORIES INC
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 6360 VAN NUYS BLVD SUITE 146
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City | VAN NUYS
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State | CA
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Zip | 91401-2638
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Country | US
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Telephone | 818-448-4954
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Fax |
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Provider Business Mailing Address
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Address Line | 6360 VAN NUYS BLVD SUITE 146
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City | VAN NUYS
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State | CA
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Zip | 91401-2638
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PETER D AMBROSE
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Credential |
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Telephone | 818-448-4954
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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 | 05D1091233
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License Number State | CA
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