Provider Demographics
NPI:1518039486
Name:ADVANCED BIOMEDICAL, INC.
Entity type:Organization
Organization Name:ADVANCED BIOMEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-239-0962
Mailing Address - Street 1:3089 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6448
Mailing Address - Country:US
Mailing Address - Phone:352-512-9770
Mailing Address - Fax:
Practice Address - Street 1:3089 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6448
Practice Address - Country:US
Practice Address - Phone:714-884-4599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB58571FMedicaid
CALAB58571FMedicaid