Provider Demographics
NPI:1578106761
Name:PREMIER PATHOLOGY MEDICAL LABORATORIES INC.
Entity Type:Organization
Organization Name:PREMIER PATHOLOGY MEDICAL LABORATORIES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEGGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-329-4164
Mailing Address - Street 1:18341 SHERMAN WAY STE 201A
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-9006
Mailing Address - Country:US
Mailing Address - Phone:323-329-4164
Mailing Address - Fax:323-544-6404
Practice Address - Street 1:18341 SHERMAN WAY STE 201A
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-9006
Practice Address - Country:US
Practice Address - Phone:323-329-4164
Practice Address - Fax:323-544-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory