Provider Demographics
NPI:1366577025
Name:KINGS COUNTY PUBLIC HEALTH LABORATORY
Entity type:Organization
Organization Name:KINGS COUNTY PUBLIC HEALTH LABORATORY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER 1
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-852-4517
Mailing Address - Street 1:330 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4375
Mailing Address - Country:US
Mailing Address - Phone:559-584-1401
Mailing Address - Fax:559-583-8178
Practice Address - Street 1:330 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4375
Practice Address - Country:US
Practice Address - Phone:559-584-1401
Practice Address - Fax:559-583-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0643454291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALAB43454FMedicaid
CA05D0643454OtherCLIA
CA1578822797OtherNPI