Provider Demographics
NPI:1629437033
Name:DNA REFERENCE LAB
Entity Type:Organization
Organization Name:DNA REFERENCE LAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL LABORATORY DIRECTOR & FTL
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:MOHAMMED
Authorized Official - Last Name:SALIH
Authorized Official - Suffix:
Authorized Official - Credentials:BVSC, MT (ASCP), MS,
Authorized Official - Phone:210-692-3800
Mailing Address - Street 1:5819 NW LOOP 410 STE 166
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-2500
Mailing Address - Country:US
Mailing Address - Phone:210-692-3800
Mailing Address - Fax:210-615-0100
Practice Address - Street 1:5819 NW LOOP 410 STE 166
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-2500
Practice Address - Country:US
Practice Address - Phone:210-692-3800
Practice Address - Fax:210-615-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D0938564291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory