Provider Demographics
NPI:1306989124
Name:SONIC LABZONE
Entity type:Organization
Organization Name:SONIC LABZONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINO
Authorized Official - Middle Name:HERRERA
Authorized Official - Last Name:ORANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-546-8791
Mailing Address - Street 1:9909 TOPANGA CANYON BLVD
Mailing Address - Street 2:SUITE 258
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3602
Mailing Address - Country:US
Mailing Address - Phone:281-546-8791
Mailing Address - Fax:281-914-4399
Practice Address - Street 1:8800 W SAM HOUSTON PKWY S
Practice Address - Street 2:SUITE 241
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77099-5208
Practice Address - Country:US
Practice Address - Phone:281-546-8791
Practice Address - Fax:281-914-4399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1063471291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D1063471OtherCLIA