Organization
LATARA ENTERPRISE INC.
Active
Other names
Foundation Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
LALA VARTANIAN (SECRETARY)
(909) 623-9301
Entity
Organization
Contact information
Practice address
1716 W HOLT AVE, POMONA, CA 91768-3333
(909) 623-9301
(909) 623-9306
Mailing address
1716 W HOLT AVE, POMONA, CA 91768-3333
(909) 623-9301
(909) 623-9306
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 489
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0642889
CLIA NUMBER
CA
05
—
LAB42889F
—
CA
01
—
X058428
PTAN
CA
Enumeration date
07/07/2006
Last updated
12/17/2012
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