Provider Demographics
NPI:1467030536
Name:WORKSITE LABS, INC.
Entity Type:Organization
Organization Name:WORKSITE LABS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-426-2766
Mailing Address - Street 1:1890 E MIRALOMA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-6746
Mailing Address - Country:US
Mailing Address - Phone:657-444-9146
Mailing Address - Fax:
Practice Address - Street 1:1890 E MIRALOMA AVE STE D
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6746
Practice Address - Country:US
Practice Address - Phone:833-747-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-31
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF-90001796OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CACLF-90002641OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CA05D2196230Medicaid
CACLF-90002704OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH
CA05D2210010Medicaid
WA50D2201374OtherWASHINGTON STATE DEPARTMENT OF HEALTH CLIA