Basic Information
| Provider Information | |||||||||
| NPI: | 1912104761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RADIATA LABORATORIES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1810 FULLERTON AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928813103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9517382229 | ||||||||
| FaxNumber: | 9517382222 | ||||||||
| Practice Location | |||||||||
| Address1: | 4900 BARRANCA PKWY | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926048603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497260682 | ||||||||
| FaxNumber: | 9496531852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MAGARELLI | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9517382229 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.