Organization
MDX-MDL HOLDINGS, LLC
Active
Other names
DIAGNOSTIC LABORATORIES
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID VELEZ (EXECUTIVE VP)
(800) 940-0389
Entity
Organization
Contact information
Practice address
10936 BIGGE ST, SAN LEANDRO, CA 94577-1121
(510) 746-0010
(510) 638-1108
Mailing address
10936 BIGGE ST, SAN LEANDRO, CA 94577-1121
(510) 746-0010
(510) 638-1108
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CU523A
MEDICARE PTAN
CA
05
—
LAB49477F
—
CA
Enumeration date
11/19/2009
Last updated
01/05/2017
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