Provider Demographics
NPI:1124524558
Name:LIVINGSTON MED LAB LLC
Entity type:Organization
Organization Name:LIVINGSTON MED LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-265-9414
Mailing Address - Street 1:18322 SONTERRA PL STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4196
Mailing Address - Country:US
Mailing Address - Phone:210-881-9072
Mailing Address - Fax:210-881-9085
Practice Address - Street 1:18322 SONTERRA PL STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4196
Practice Address - Country:US
Practice Address - Phone:210-881-9072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-04
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory