Provider Demographics
NPI:1851748008
Name:TERRATOX LABORATORIES, INC.
Entity Type:Organization
Organization Name:TERRATOX LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-244-1115
Mailing Address - Street 1:3419 VIA LIDO
Mailing Address - Street 2:SUITE 668
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6510 WEST 91ST AVE
Practice Address - Street 2:SUITE 90
Practice Address - City:WESTMINISTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2929
Practice Address - Country:US
Practice Address - Phone:949-244-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory