Provider Demographics
NPI:1376297697
Name:LA TEST CONNECT
Entity Type:Organization
Organization Name:LA TEST CONNECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MADINA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-496-7933
Mailing Address - Street 1:3600 E PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2015
Mailing Address - Country:US
Mailing Address - Phone:509-496-7933
Mailing Address - Fax:
Practice Address - Street 1:3600 E PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2015
Practice Address - Country:US
Practice Address - Phone:509-496-7933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-06
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service