Provider Demographics
NPI:1457341851
Name:PACIFIC POINT LABORATORIES, INC.
Entity Type:Organization
Organization Name:PACIFIC POINT LABORATORIES, INC.
Other - Org Name:WESTPAC LABS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:214-237-1641
Mailing Address - Street 1:3701 S HIGUERA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7462
Mailing Address - Country:US
Mailing Address - Phone:805-541-6033
Mailing Address - Fax:805-541-6116
Practice Address - Street 1:3701 S HIGUERA ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7462
Practice Address - Country:US
Practice Address - Phone:805-541-6033
Practice Address - Fax:805-541-6916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory