Provider Demographics
NPI:1891492112
Name:1ST CAPITAL BIO LAB, LLC
Entity Type:Organization
Organization Name:1ST CAPITAL BIO LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PIETRO
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-837-8140
Mailing Address - Street 1:38340 INNOVATION CT # E-511
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-892-3448
Practice Address - Street 1:38340 INNOVATION CT # E-511
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2621
Practice Address - Country:US
Practice Address - Phone:951-837-8140
Practice Address - Fax:888-892-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory