Provider Demographics
NPI:1689056855
Name:LIBERTY LABORATORY LLC
Entity Type:Organization
Organization Name:LIBERTY LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROCHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:714-593-5356
Mailing Address - Street 1:10760 WARNER AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3857
Mailing Address - Country:US
Mailing Address - Phone:714-593-5356
Mailing Address - Fax:714-593-5366
Practice Address - Street 1:10760 WARNER AVE STE 201
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3857
Practice Address - Country:US
Practice Address - Phone:714-593-5356
Practice Address - Fax:714-593-5366
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY LABORATORY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory