Provider Demographics
NPI:1558528851
Name:THE SIMIAN DIAGNOSTIC LABORATORY, LTD
Entity Type:Organization
Organization Name:THE SIMIAN DIAGNOSTIC LABORATORY, LTD
Other - Org Name:VRL LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-615-7275
Mailing Address - Street 1:PO BOX 40100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-1100
Mailing Address - Country:US
Mailing Address - Phone:210-615-7275
Mailing Address - Fax:
Practice Address - Street 1:7540 LOUIS PASTEUR
Practice Address - Street 2:STE 250
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4018
Practice Address - Country:US
Practice Address - Phone:210-615-7275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
45D1081732OtherCLIA