Provider Demographics
NPI:1922346758
Name:BROWN LABORATORY
Entity Type:Organization
Organization Name:BROWN LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALONZO
Authorized Official - Last Name:GANONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-321-6173
Mailing Address - Street 1:12021 WILSHIRE BLVD
Mailing Address - Street 2:#438
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1206
Mailing Address - Country:US
Mailing Address - Phone:661-321-6173
Mailing Address - Fax:661-327-3395
Practice Address - Street 1:10289 BANNOCKBURN DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4706
Practice Address - Country:US
Practice Address - Phone:661-321-6173
Practice Address - Fax:661-327-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D2051152291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory