Provider Demographics
NPI:1023368933
Name:DOC'S LAB SERVICES, LLC
Entity Type:Organization
Organization Name:DOC'S LAB SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SEPULVEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-579-0561
Mailing Address - Street 1:PO BOX 4193
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4193
Mailing Address - Country:US
Mailing Address - Phone:956-510-8898
Mailing Address - Fax:956-510-8852
Practice Address - Street 1:1919 OAKWELL FARMS PKWY STE 180
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-1777
Practice Address - Country:US
Practice Address - Phone:210-579-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D2045368291U00000X
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D2045368OtherCLIA
TX290117Medicare PIN
TX3247942-01Medicaid