Provider Demographics
NPI:1811642226
Name:BLUEBIO USA LABORATORY
Entity type:Organization
Organization Name:BLUEBIO USA LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-822-3303
Mailing Address - Street 1:1 PETERS CANYON RD STE 160
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1748
Mailing Address - Country:US
Mailing Address - Phone:949-822-3303
Mailing Address - Fax:949-223-1887
Practice Address - Street 1:1 PETERS CANYON RD STE 160
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-1748
Practice Address - Country:US
Practice Address - Phone:949-822-3303
Practice Address - Fax:949-223-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-14
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D2222409OtherFEDERAL CLIA LICENSE
CACDF-900003500OtherSTATE CLIA LICENSE