Provider Demographics
NPI:1437748076
Name:PERSONAL SPACE TESTING
Entity Type:Organization
Organization Name:PERSONAL SPACE TESTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIELD OPERATIONS EXECUTIVE
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:310-999-9824
Mailing Address - Street 1:PO BOX 437
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-0437
Mailing Address - Country:US
Mailing Address - Phone:310-999-9824
Mailing Address - Fax:
Practice Address - Street 1:25657 PINE CREEK LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-1823
Practice Address - Country:US
Practice Address - Phone:310-999-9824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No291U00000XLaboratoriesClinical Medical Laboratory