Provider Demographics
NPI:1568454494
Name:CONSOLIDATED MEDICAL BIO-ANALYSIS INC
Entity Type:Organization
Organization Name:CONSOLIDATED MEDICAL BIO-ANALYSIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHIN
Authorized Official - Middle Name:KUO
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:714-657-7369
Mailing Address - Street 1:10700 WALKER ST
Mailing Address - Street 2:PO BOX 2369
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4703
Mailing Address - Country:US
Mailing Address - Phone:714-657-7369
Mailing Address - Fax:714-657-7393
Practice Address - Street 1:10700 WALKER ST
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4703
Practice Address - Country:US
Practice Address - Phone:714-657-7369
Practice Address - Fax:714-657-7393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF3441291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAX059441Medicare ID - Type UnspecifiedCLINICAL MEDICAL LABORATO