Provider Demographics
NPI:1023360039
Name:MED-X DRUG & ALCOHOL TESTING SERVICES
Entity Type:Organization
Organization Name:MED-X DRUG & ALCOHOL TESTING SERVICES
Other - Org Name:MEDICAL INDUSTRIAL EVALUATORS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATORS
Authorized Official - Prefix:MR
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LAURENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-207-3320
Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 825
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-207-3320
Mailing Address - Fax:
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:SUITE 825
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-207-3320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44883114173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty