Organization
LAB GENOMICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSHAM MANAKTALA CLS (EXECUTIVE ADMINISTRATION)
(714) 336-1379
Entity
Organization
Contact information
Practice address
11160 WARNER AVE STE 415, FOUNTAIN VALLEY, CA 92708-4056
(714) 438-1009
(714) 438-2484
Mailing address
11160 WARNER AVE STE 415, FOUNTAIN VALLEY, CA 92708-4056
(714) 438-1009
(714) 438-2484
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF00341087
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2026572
CLINICAL LAB IMPROVEMENT AMMENDMENT
—
01
—
CLF00341087
CALIFORNIA STATE
CA
Enumeration date
07/21/2011
Last updated
08/08/2012
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