Provider Demographics
NPI:1699861815
Name:WHITEFIELD MEDICAL LABORATORY INC
Entity type:Organization
Organization Name:WHITEFIELD MEDICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAXPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-625-2114
Mailing Address - Street 1:764 INDIGO COURT
Mailing Address - Street 2:#A
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-625-2114
Mailing Address - Fax:909-625-7735
Practice Address - Street 1:764 INDIGO COURT
Practice Address - Street 2:#A
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-625-2114
Practice Address - Fax:909-625-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLIA 05D0716660291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB04252FMedicaid
CALAB04252FMedicaid