MEDICARE: FOUNDATION LABS LLC

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	:	1639642564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION LABS LLC

Provider Business Mailing Address
First Line	:	PO BOX 3387
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-2387
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E 28TH ST STE 116
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2771
Country	:	US
Telephone Number	:	562-206-0744
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ANOOPJIT LOHARA
Credential	:
Telephone Number	:	562-353-5907

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	08/05/2024

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