Provider Demographics
NPI:1023342649
Name:ODYSSEY CLINICAL LABORATORIES
Entity type:Organization
Organization Name:ODYSSEY CLINICAL LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-593-6999
Mailing Address - Street 1:2061 WRIGHT ST
Mailing Address - Street 2:SUITE A3
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-5837
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2061 WRIGHT ST
Practice Address - Street 2:SUITE A3
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5837
Practice Address - Country:US
Practice Address - Phone:909-593-6999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory