Provider Demographics
NPI:1003904673
Name:CORE ANALYTICS LABORATORY, INC
Entity Type:Organization
Organization Name:CORE ANALYTICS LABORATORY, INC
Other - Org Name:CERF DIAGNOSTIC LABORATORY, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KINGSLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LABROSSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-906-2614
Mailing Address - Street 1:7316 DEERING AVE
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1503
Mailing Address - Country:US
Mailing Address - Phone:818-906-2614
Mailing Address - Fax:818-444-0385
Practice Address - Street 1:7316 DEERING AVE
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1503
Practice Address - Country:US
Practice Address - Phone:818-906-2614
Practice Address - Fax:818-444-0385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11367291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0928967OtherCLIA NUMBER
CALAB28967GMedicaid
CA5988936OtherPIN #