Provider Demographics
NPI:1275863540
Name:TEXANA LABS INC
Entity Type:Organization
Organization Name:TEXANA LABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-302-3499
Mailing Address - Street 1:5424 LAUREL CANYON BLVD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-4612
Mailing Address - Country:US
Mailing Address - Phone:818-302-3499
Mailing Address - Fax:818-301-3760
Practice Address - Street 1:12626 RIVERSIDE DR
Practice Address - Street 2:STE 409
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3420
Practice Address - Country:US
Practice Address - Phone:818-302-3499
Practice Address - Fax:818-301-3760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104222207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty