Provider Demographics
NPI:1427435361
Name:CALIFORNIA STAT LABORATORIES
Entity type:Organization
Organization Name:CALIFORNIA STAT LABORATORIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MSC
Authorized Official - Phone:909-809-1494
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-0638
Mailing Address - Country:US
Mailing Address - Phone:909-219-4131
Mailing Address - Fax:909-512-6492
Practice Address - Street 1:1350 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3332
Practice Address - Country:US
Practice Address - Phone:909-219-4131
Practice Address - Fax:909-512-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 347539291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory