Clinical Pathology Laboratory of Antalope Valley

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

05DO862432 Issued in CA

Legal business name

CLINICAL PATHOLOGY LABORATORY OF ANTALOPE VALLEY

Practice address

41210 11TH St West
Suite I
Palmdale, CA 93551

Phone

(661) 267-7733

Fax

(661) 273-3096

NPI assigned

Aug 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Louis Brahen, MD

Title

Medical Director Owner

Phone

(661) 267-7733

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629084488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41210 11TH ST WEST",
            "address_2": "SUITE I",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "93551",
            "telephone_number": "661-267-7733",
            "fax_number": "661-273-3096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41210 11TH ST WEST",
            "address_2": "SUITE I",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "93551",
            "telephone_number": "661-267-7733",
            "fax_number": "661-273-3096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICAL PATHOLOGY LABORATORY OF ANTALOPE VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRAHEN",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR OWNER",
        "authorized_official_telephone_number": "661-267-7733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "05DO862432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB09501F",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "C19379",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Palmdale, CA
• Providers in Palmdale, 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 Aug 22, 2020; 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.