Provider Demographics
NPI:1972967933
Name:FOUR TECH LABORATORY LLC
Entity Type:Organization
Organization Name:FOUR TECH LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-401-2583
Mailing Address - Street 1:5132 PECK RD
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-1426
Mailing Address - Country:US
Mailing Address - Phone:626-401-2583
Mailing Address - Fax:626-401-2618
Practice Address - Street 1:5132 PECK RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-1426
Practice Address - Country:US
Practice Address - Phone:626-401-2583
Practice Address - Fax:626-401-2618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-06
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 349083291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory