Provider Demographics
NPI:1902331622
Name:MISSION TOXICOLOGY, LLC
Entity Type:Organization
Organization Name:MISSION TOXICOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZATIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-475-7784
Mailing Address - Street 1:PO BOX 894388
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90189-4388
Mailing Address - Country:US
Mailing Address - Phone:951-475-7784
Mailing Address - Fax:951-384-2820
Practice Address - Street 1:23052 ALICIA PKWY
Practice Address - Street 2:STE H495
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-1643
Practice Address - Country:US
Practice Address - Phone:951-475-7784
Practice Address - Fax:951-384-2820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory