Basic Information
| Provider Information | |||||||||
| NPI: | 1952467235 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNILAB CORPORATION | ||||||||
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| OtherOrganizationName: | QUEST DIAGNOSTICS INCORPORATED | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 ADAMS AVE | ||||||||
| Address2: | MRGOV 2ND FLOOR | ||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194032429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4846767000 | ||||||||
| FaxNumber: | 4846765309 | ||||||||
| Practice Location | |||||||||
| Address1: | 212 SAN JOSE ST | ||||||||
| Address2: | STE 101 | ||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314243452 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2006 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | CARTIER | ||||||||
| AuthorizedOfficialFirstName: | GERALD | ||||||||
| AuthorizedOfficialMiddleName: | SCOTT | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF REVENUE SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4846767000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | QUEST DIAGNOSTICS INCORPORATED | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 05D0590226 | CA | Y | Laboratories | Clinical Medical Laboratory |
ID Information
| ID | Type | State | Issuer | Description | LAB90226F | 01 | CA | MEDI-CAL | OTHER |