Provider Demographics
NPI:1821057407
Name:ARBOR VITA CORPORATION
Entity Type:Organization
Organization Name:ARBOR VITA CORPORATION
Other - Org Name:HEMEDIAGNOSTICS, LAB, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-793-3686
Mailing Address - Street 1:48371 FREMONT BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-6554
Mailing Address - Country:US
Mailing Address - Phone:650-793-3686
Mailing Address - Fax:510-573-4758
Practice Address - Street 1:48371 FREMONT BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-6554
Practice Address - Country:US
Practice Address - Phone:650-793-3686
Practice Address - Fax:510-573-4758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G654880OtherBLUE SHIELD
CALAB21148FMedicaid
CA00G654880OtherBLUE SHIELD