Provider Demographics
NPI:1285041558
Name:UB LABORATORIES, INC.
Entity Type:Organization
Organization Name:UB LABORATORIES, INC.
Other - Org Name:HEALTH 360 LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OZMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHIUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-428-1771
Mailing Address - Street 1:25901 COMMERCENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-8805
Mailing Address - Country:US
Mailing Address - Phone:877-509-0376
Mailing Address - Fax:
Practice Address - Street 1:25901 COMMERCENTRE DR STE 300
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-8805
Practice Address - Country:US
Practice Address - Phone:877-509-0376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF346019291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2080395Medicare UPIN