Provider Demographics
NPI:1366446718
Name:SCANTIBODIES CLINICAL LABORATORY INC
Entity Type:Organization
Organization Name:SCANTIBODIES CLINICAL LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-249-1212
Mailing Address - Street 1:9236 ABRAHAM WAY
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-5611
Mailing Address - Country:US
Mailing Address - Phone:619-258-2731
Mailing Address - Fax:619-258-2806
Practice Address - Street 1:9236 ABRAHAM WAY
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-5611
Practice Address - Country:US
Practice Address - Phone:619-258-2731
Practice Address - Fax:619-258-2806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 11679291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10749OtherCITY OF SANTEE BUSINESS L
CACLF 11679OtherLAB ID NUMBER