Provider Demographics
NPI:1831219484
Name:ONE SOURCE TOXICOLOGY LABORATORY
Entity type:Organization
Organization Name:ONE SOURCE TOXICOLOGY LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCIENTIFIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUBBARAO
Authorized Official - Middle Name:V
Authorized Official - Last Name:KALA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-920-2559
Mailing Address - Street 1:1213 GENOA RED BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-4030
Mailing Address - Country:US
Mailing Address - Phone:713-920-2559
Mailing Address - Fax:281-998-8587
Practice Address - Street 1:1213 GENOA RED BLUFF RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-4030
Practice Address - Country:US
Practice Address - Phone:713-920-2559
Practice Address - Fax:281-998-8587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory