Provider Demographics
NPI:1396368528
Name:WEST COAST TLC REPRODUCTIVE LABORATORY
Entity Type:Organization
Organization Name:WEST COAST TLC REPRODUCTIVE LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HCLD
Authorized Official - Prefix:DR
Authorized Official - First Name:MAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-344-8522
Mailing Address - Street 1:18370 BURBANK BLVD STE 507
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2840
Mailing Address - Country:US
Mailing Address - Phone:818-344-8522
Mailing Address - Fax:818-344-8521
Practice Address - Street 1:18370 BURBANK BLVD STE 507
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2840
Practice Address - Country:US
Practice Address - Phone:818-344-8522
Practice Address - Fax:818-344-8521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory