Av Prime Lab LLC

Primary specialty

Pathology Specialist/TechnologistTaxonomy code 246Q00000X

Legal business name

AV PRIME LAB LLC

Practice address

1220 East Avenue S
Suite L
Palmdale, CA 93550

Phone

(661) 947-1288

Fax

(661) 947-1844

NPI assigned

Mar 23, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Nicholas Magno Lomibao, CLS MTA 33999 CALIF

Title

Clin Laboratory Scientist Manager

Phone

(661) 947-1288

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1740307040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 EAST AVENUE S",
            "address_2": "SUITE L",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "93550",
            "telephone_number": "661-947-1288",
            "fax_number": "661-947-1844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 EAST AVENUE S",
            "address_2": "SUITE L",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "93550",
            "telephone_number": "661-947-1288",
            "fax_number": "661-947-1844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AV PRIME LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LOMIBAO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "MAGNO",
        "authorized_official_title_or_position": "CLIN LABORATORY SCIENTIST MANAGER",
        "authorized_official_telephone_number": "661-947-1288",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CLS MTA 33999 CALIF"
    },
    "taxonomies": [
        {
            "code": "246Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Pathology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pathology Specialist/Technologist in Palmdale, CA
• Providers in Palmdale, CA by specialty
• Pathology Specialist/Technologist 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.