Provider Demographics
NPI:1366850901
Name:MEDITEST LABORATORIES
Entity Type:Organization
Organization Name:MEDITEST LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-243-0205
Mailing Address - Street 1:17971 SKYPARK CIRCLE
Mailing Address - Street 2:33E
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4394
Mailing Address - Country:US
Mailing Address - Phone:949-243-0205
Mailing Address - Fax:888-242-0581
Practice Address - Street 1:17971 SKYPARK CIRCLE
Practice Address - Street 2:33E
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4394
Practice Address - Country:US
Practice Address - Phone:949-243-0205
Practice Address - Fax:888-242-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-28
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA346204291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory