Provider Demographics
NPI:1093449936
Name:SOUTHWEST SCIENCE LABS
Entity type:Organization
Organization Name:SOUTHWEST SCIENCE LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORRAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-694-9342
Mailing Address - Street 1:2401 W 208TH ST UNIT C9
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-6212
Mailing Address - Country:US
Mailing Address - Phone:106-949-3423
Mailing Address - Fax:
Practice Address - Street 1:2401 W 208TH ST UNIT C9
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-6212
Practice Address - Country:US
Practice Address - Phone:310-694-9342
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory