Provider Demographics
NPI:1467786384
Name:QUALTEK MOLECULAR LABORATORIES
Entity Type:Organization
Organization Name:QUALTEK MOLECULAR LABORATORIES
Other - Org Name:QUALTEK CLINICAL LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:805-681-3200
Mailing Address - Street 1:6483 CALLE REAL
Mailing Address - Street 2:SUITE A
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117
Mailing Address - Country:US
Mailing Address - Phone:805-681-3200
Mailing Address - Fax:805-830-6379
Practice Address - Street 1:6483 CALLE REAL
Practice Address - Street 2:SUITE A
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117
Practice Address - Country:US
Practice Address - Phone:805-681-3200
Practice Address - Fax:805-830-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246Q00000X
CACLF338025291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical Laboratory
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyGroup - Multi-Specialty