Provider Demographics
NPI:1770778813
Name:WHITEFIELD MEDICAL LABORATORY INC
Entity type:Organization
Organization Name:WHITEFIELD MEDICAL LABORATORY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JATIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAXPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-622-3166
Mailing Address - Street 1:1818 N ORANGEGROVE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767
Mailing Address - Country:US
Mailing Address - Phone:909-622-3166
Mailing Address - Fax:909-622-8046
Practice Address - Street 1:1818 N ORANGEGROVE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767
Practice Address - Country:US
Practice Address - Phone:909-622-3166
Practice Address - Fax:909-622-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A334740Medicaid
CAGR0083060Medicaid
CAW18019Medicare UPIN
TG079Medicare PIN
CA00A334740Medicaid
CAWA33474AMedicare UPIN
CAA27162Medicare UPIN