MEDICARE: INTEGRATED LABORATORIES ADVISORY GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1164021085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED LABORATORIES ADVISORY GROUP, INC.

Provider Business Mailing Address
First Line	:	7 W FIGUEROA ST STE 300
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-3189
Country	:	US
Telephone Number	:	805-892-6151
Fax Number	:	805-892-6150

Provider Business Practice Location Address
First Line	:	7 W FIGUEROA ST STE 300
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93101-3189
Country	:	US
Telephone Number	:	805-892-6151
Fax Number	:	805-892-6150

Authorized Official
Title or Position	:	CFO
Name	:	KRISTOPHER PARK
Credential	:
Telephone Number	:	805-892-6151

Provider Enumeration Date	:	10/21/2020
Last Update Date	:	10/21/2020

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