Provider Demographics
NPI:1366587503
Name:WESTERN HEALTH SCIENCES MEDICAL LAB
Entity type:Organization
Organization Name:WESTERN HEALTH SCIENCES MEDICAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-773-9771
Mailing Address - Street 1:21018 OSBORNE ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-1736
Mailing Address - Country:US
Mailing Address - Phone:818-773-9771
Mailing Address - Fax:818-773-9814
Practice Address - Street 1:21018 OSBORNE ST STE 3
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-1736
Practice Address - Country:US
Practice Address - Phone:818-773-9771
Practice Address - Fax:818-773-9814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF4149291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB04149FMedicaid
CA=========OtherALL INSURANCES
CALAB04149FMedicaid