Provider Demographics
NPI:1164021085
Name:INTEGRATED LABORATORIES ADVISORY GROUP, INC.
Entity Type:Organization
Organization Name:INTEGRATED LABORATORIES ADVISORY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-892-6151
Mailing Address - Street 1:7 W FIGUEROA ST STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3189
Mailing Address - Country:US
Mailing Address - Phone:805-892-6151
Mailing Address - Fax:805-892-6150
Practice Address - Street 1:7 W FIGUEROA ST STE 300
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3189
Practice Address - Country:US
Practice Address - Phone:805-892-6151
Practice Address - Fax:805-892-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory