Provider Demographics
NPI:1255657219
Name:ADVANCE MEDICAL LAB
Entity Type:Organization
Organization Name:ADVANCE MEDICAL LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LAB TECH
Authorized Official - Prefix:MR
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-581-5555
Mailing Address - Street 1:2016 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3223
Mailing Address - Country:US
Mailing Address - Phone:956-581-5555
Mailing Address - Fax:956-581-5573
Practice Address - Street 1:2016 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3223
Practice Address - Country:US
Practice Address - Phone:956-581-5555
Practice Address - Fax:956-581-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory