Provider Demographics
NPI:1194478867
Name:SECOND BIO LAB CLINICAL LABORATORY
Entity type:Organization
Organization Name:SECOND BIO LAB CLINICAL LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORUE-PEREA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-484-1315
Mailing Address - Street 1:316 E LAS TUNAS DR STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1535
Mailing Address - Country:US
Mailing Address - Phone:626-300-8880
Mailing Address - Fax:626-300-8811
Practice Address - Street 1:316 E LAS TUNAS DR STE 206
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1535
Practice Address - Country:US
Practice Address - Phone:626-300-8880
Practice Address - Fax:626-300-8811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory