Basic Information
| Provider Information | |||||||||
| NPI: | 1457389959 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COUNTY OF TULARE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TULARE COUNTY PUBLIC HEALTH LABORATORY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5957 S MOONEY BLVD | ||||||||
| Address2: | |||||||||
| City: | VISALIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932779394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596248480 | ||||||||
| FaxNumber: | 5596241071 | ||||||||
| Practice Location | |||||||||
| Address1: | 1062 S K ST | ||||||||
| Address2: | |||||||||
| City: | TULARE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932746421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596852684 | ||||||||
| FaxNumber: | 5596852514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 05/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | DUERKSEN | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | AGENCY DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5596248000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.