Provider Demographics
NPI:1699704395
Name:QUALITY CLINICAL LAB SCIENCE, INC
Entity type:Organization
Organization Name:QUALITY CLINICAL LAB SCIENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIKTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:SALATA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-246-5163
Mailing Address - Street 1:1101 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1383
Mailing Address - Country:US
Mailing Address - Phone:818-246-5163
Mailing Address - Fax:
Practice Address - Street 1:1101 E BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1383
Practice Address - Country:US
Practice Address - Phone:818-246-5163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11340291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory