Organization
PROST DATA INC
Active
Other names
OUR Lab
Organization subpart
No
Provider details
NPI number
Authorized official
TANYA FEINBERG (VP OF OPERATIONS)
(615) 874-0410
Entity
Organization
Contact information
Practice address
875 COWAN RD, SUITE B, BURLINGAME, CA 94010-1204
(615) 874-0410
(615) 345-4653
Mailing address
875 COWAN RD, SUITE B, BURLINGAME, CA 94010-1204
(615) 874-0410
(615) 345-4653
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D2022063
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D2022063
CLIA
CA
Enumeration date
04/06/2011
Last updated
01/10/2013
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