Provider Demographics
NPI:1841685971
Name:FBLT MANAGEMENT LLC
Entity type:Organization
Organization Name:FBLT MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BIRGER
Authorized Official - Middle Name:GREG
Authorized Official - Last Name:BACINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-525-5744
Mailing Address - Street 1:PO BOX 3881
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-3881
Mailing Address - Country:US
Mailing Address - Phone:858-935-7745
Mailing Address - Fax:888-214-0437
Practice Address - Street 1:5755 OBERLIN DR STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4717
Practice Address - Country:US
Practice Address - Phone:858-935-7745
Practice Address - Fax:888-214-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No3336C0004XSuppliersPharmacyCompounding Pharmacy