Provider Demographics
NPI:1093449936
Name:SOUTHWEST SCIENCE LABS
Entity Type:Organization
Organization Name:SOUTHWEST SCIENCE LABS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-722-4454
Mailing Address - Street 1:28934 S WESTERN AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-0814
Mailing Address - Country:US
Mailing Address - Phone:847-722-4454
Mailing Address - Fax:
Practice Address - Street 1:28934 S WESTERN AVE STE 210
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-0814
Practice Address - Country:US
Practice Address - Phone:847-722-4454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory