Organization
CLINICAL PATHOLOGY LABORATORY OF ANTALOPE VALLEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LOUIS BRAHEN MD (MEDICAL DIRECTOR OWNER)
(661) 267-7733
Entity
Organization
Contact information
Practice address
41210 11TH ST WEST, SUITE I, PALMDALE, CA 93551
(661) 267-7733
(661) 273-3096
Mailing address
41210 11TH ST WEST, SUITE I, PALMDALE, CA 93551
(661) 267-7733
(661) 273-3096
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05DO862432
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C19379
LICENSE
CA
05
—
LAB09501F
—
CA
Enumeration date
08/01/2006
Last updated
08/22/2020
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