Organization
BIODATA MEDICAL LABORATORIES, INC
Active
Organization
BIODATA MEDICAL LABORATORIES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HENRY WALLACH CLS (CEO)
(909) 445-9727
Entity
Organization
Contact information
Practice address
5494 ARROW HWY, MONTCLAIR, CA 91763-1604
(909) 445-9727
(909) 445-9608
Mailing address
691 COVEWOOD ST, OAK PARK, CA 91377-4778
(805) 217-6212
(909) 445-9608
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF11434
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LAB38572F
—
CA
Enumeration date
10/12/2006
Last updated
04/19/2012
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