Biodata Medical Laboratories, Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF11434 Issued in CA

Legal business name

BIODATA MEDICAL LABORATORIES, INC

Practice address

5494 Arrow Hwy
Montclair, CA 91763-1604

Phone

(909) 445-9727

Fax

(909) 445-9608

NPI assigned

Oct 12, 2006

Last updated

Apr 19, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Henry Wallach, CLS

Title

Ceo

Phone

(909) 445-9727

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334793600000",
    "number": "1558450601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "691 COVEWOOD ST",
            "city": "OAK PARK",
            "state": "CA",
            "postal_code": "913774778",
            "telephone_number": "805-217-6212",
            "fax_number": "909-445-9608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5494 ARROW HWY",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917631604",
            "telephone_number": "909-445-9727",
            "fax_number": "909-445-9608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIODATA MEDICAL LABORATORIES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2012-04-19",
        "status": "A",
        "authorized_official_last_name": "WALLACH",
        "authorized_official_first_name": "HENRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-445-9727",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CLS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF11434",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB38572F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Montclair, CA
• Providers in Montclair, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.