Provider Demographics
NPI:1790011054
Name:CALIFORNIA LABORATORY SCIENCES LLC
Entity Type:Organization
Organization Name:CALIFORNIA LABORATORY SCIENCES LLC
Other - Org Name:WEST PACIFIC MEDICAL LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-906-5227
Mailing Address - Street 1:10200 PIONEER BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-6000
Mailing Address - Country:US
Mailing Address - Phone:562-906-5227
Mailing Address - Fax:562-906-6450
Practice Address - Street 1:10200 PIONEER BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6000
Practice Address - Country:US
Practice Address - Phone:562-906-5227
Practice Address - Fax:562-906-6450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-21
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D0866459Medicare UPIN