Provider Demographics
NPI:1255797148
Name:FPG LABS OF AUSTIN, LLC
Entity type:Organization
Organization Name:FPG LABS OF AUSTIN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GOLDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-536-7738
Mailing Address - Street 1:15821 VENTURA BLVD
Mailing Address - Street 2:SUITE 625
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4793
Mailing Address - Country:US
Mailing Address - Phone:818-858-1080
Mailing Address - Fax:323-729-3933
Practice Address - Street 1:6500 N MO PAC EXPY
Practice Address - Street 2:BUILDING 3, SUITE 3102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3282
Practice Address - Country:US
Practice Address - Phone:512-610-7475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D1021548291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory