Provider Demographics
NPI:1649367368
Name:PHYSICIANS LABORATORIES, INC
Entity type:Organization
Organization Name:PHYSICIANS LABORATORIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PACITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-856-3667
Mailing Address - Street 1:4900 MILL ST STE 10A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-2391
Mailing Address - Country:US
Mailing Address - Phone:775-856-3667
Mailing Address - Fax:775-856-3668
Practice Address - Street 1:4900 MILL ST STE 10A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2391
Practice Address - Country:US
Practice Address - Phone:775-856-3667
Practice Address - Fax:775-856-3668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV34234Medicare ID - Type Unspecified