Provider Demographics
NPI:1750630885
Name:PROOVE MEDICAL LABORATORIES, INC.
Entity Type:Organization
Organization Name:PROOVE MEDICAL LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MESHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-776-6832
Mailing Address - Street 1:15326 ALTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2338
Mailing Address - Country:US
Mailing Address - Phone:855-776-6832
Mailing Address - Fax:888-233-6857
Practice Address - Street 1:26 TECHNOLOGY DR. EAST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2380
Practice Address - Country:US
Practice Address - Phone:855-776-6832
Practice Address - Fax:888-233-6857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGO12076291U00000X
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory