Provider Demographics
NPI:1346912599
Name:LABORATORY SERVICES DME
Entity Type:Organization
Organization Name:LABORATORY SERVICES DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-363-2317
Mailing Address - Street 1:245 FISCHER AVE STE A2
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4536
Mailing Address - Country:US
Mailing Address - Phone:714-363-2317
Mailing Address - Fax:
Practice Address - Street 1:245 FISCHER AVE STE A2
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4536
Practice Address - Country:US
Practice Address - Phone:714-363-2317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies