Provider Demographics
NPI:1477602639
Name:PACIFIC DIAGNOSTIC LABORATORIES
Entity Type:Organization
Organization Name:PACIFIC DIAGNOSTIC LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-569-7224
Mailing Address - Street 1:454 S PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2404
Mailing Address - Country:US
Mailing Address - Phone:805-879-8100
Mailing Address - Fax:805-879-8173
Practice Address - Street 1:454 S PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2404
Practice Address - Country:US
Practice Address - Phone:805-692-4610
Practice Address - Fax:805-879-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF1280291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory