Organization
EPINEX DIAGNOSTICS LABORATORIES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRI BHARAT MADIREDDY PH.D. (C.E.O.)
(561) 249-4317
Entity
Organization
Contact information
Practice address
14351 MYFORD RD, SUITE K, TUSTIN, CA 92780-7074
(949) 464-5682
(714) 731-1229
Mailing address
14351 MYFORD RD, SUITE K, TUSTIN, CA 92780-7074
(949) 464-5682
(714) 731-7229
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF00340713
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2025713
CLIA
—
01
—
FU287A
MEDICARE PTAN
—
Enumeration date
10/24/2011
Last updated
05/16/2016
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