Provider Demographics
NPI:1003261165
Name:CBD LABORATORIES INC.
Entity Type:Organization
Organization Name:CBD LABORATORIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-550-2211
Mailing Address - Street 1:PO BOX 51438
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-5738
Mailing Address - Country:US
Mailing Address - Phone:855-277-5363
Mailing Address - Fax:
Practice Address - Street 1:1301 E UNIVERSITY DR
Practice Address - Street 2:AZTEC COURT, SUITE 131
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-8405
Practice Address - Country:US
Practice Address - Phone:951-323-7366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONVALO HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-26
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory