Provider Demographics
NPI:1811194939
Name:MPOL LABORATORY LLC
Entity Type:Organization
Organization Name:MPOL LABORATORY LLC
Other - Org Name:MPOL LABORATORY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BASEER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:951-735-9190
Mailing Address - Street 1:1888 W 6TH ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2993
Mailing Address - Country:US
Mailing Address - Phone:951-735-9190
Mailing Address - Fax:951-340-2846
Practice Address - Street 1:1888 W 6TH ST
Practice Address - Street 2:SUITE H
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2993
Practice Address - Country:US
Practice Address - Phone:951-735-9190
Practice Address - Fax:951-340-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF4840291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0543719OtherCLIA ID
CALAB54371GOtherMEDI-CAL